Thromboelastometric Profile and Acute Coagulopathy of the Polytraumatized Patient: Clinical and Prognostic Implications

• Published in: Cirugia española (English ed.) Vol. 96; no. 1; pp. 41 - 48
• Main Authors: Bonet, Antònia, Madrazo, Zoilo, Koo, Maylin, Otero, Israel, Mallol, Montserrat, Macia, Irene, Ramirez, Luciano, Sabaté, Antoni
• Format: Journal Article
• Language: English
• Published: Spain Elsevier España 01-01-2018
• Subjects: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Blood Coagulation Disorders - blood; Blood Coagulation Disorders - epidemiology; Coagulopathy; Coagulopatía; Female; Humans; Male; Middle Aged; Multiple Trauma - blood; Politraumatizado; Polytraumatized; Prevalence; Prognosis; Prospective Studies; Thrombelastography; Thromboelastogram; Tromboelastograma; Young Adult; Coagulopatía; Polytraumatized; Thromboelastogram; Tromboelastograma; Coagulopathy; Politraumatizado
• ISSN: 2173-5077; 2173-5077
• DOI: 10.1016/j.cireng.2017.09.012

About 25%–35% of polytraumatized patients have a profound alteration of hemostasis on arrival at the hospital (acute traumatic coagulopathy [CAT]). Viscoelastic tests (ROTEM®) measure the hemostatic capacity and provide an early detection of CAT. The objectives of this study are to describe the initial thromboelastogram of these patients and to determine the prevalence of CAT according to predefined thromboelastographic profiles.
Single-center, observational, prospective study in polytraumatic patients. Initial blood and thromboelastographic test (ROTEM®) were made, and pre-hospital, hospital, transfusion, initial surgical/angiographic interventions, cardiac arrest and mortality data were collected. ROTEM®-based, patients were classified as: normal, hypercoagulable, hypocoagulable, hypocoagulable+hyperfibrinolytic and isolated hyperfibrinolysis.
One hundred and twenty-three patients were analyzed. 32 cases (26%) with CAT: 15 patients with hypocoagulability, 9 with hyperfibrinolysis alone and 8 with hypocoagulability+hyperfibrinolysis. The CAT group, related to the normal group, presented higher ISS (23 vs 16, P<.01), higher blood products transfusion (2.5 vs 0; P=.001), more cardiac arrest (19 vs 1%, P<.01), and higher mortality (34 vs 5%, P<.01). The subgroup with hypocoagulability/hyperfibrinolysis, related to the groups with hypocoagulability or hyperfibrinolysis alone, presented a higher ISS (41 vs 25 vs 15, P<.01), higher angiographic procedures (62% vs 13% vs 0%, P<.01) and higher mortality (75% vs 33% vs 0%, P=.05).
Twenty-six percent of the polytrauma patients presented early coagulopathy assessed by thromboelastography. It is associated with higher consumption of blood products and lower survival. The presence of hypocoagulability+hyperfibrinolysis is associated with greater severity and a higher requirement of blood products.
El 25-35% de los pacientes politraumatizados presentan profundas alteraciones de la coagulación a su llegada al hospital (coagulopatía aguda traumática [CAT]). Los test viscoelásticos (ROTEM®) valoran rápidamente la capacidad hemostática y detectan precozmente la CAT. Los objetivos de este estudio son describir el tromboelastograma inicial de estos enfermos y determinar la prevalencia de CAT según unos perfiles tromboelastográficos predefinidos.
Estudio unicéntrico, observacional y prospectivo en pacientes politraumatizados. Se realizó analítica, prueba tromboelastográfica (ROTEM®) y se registraron datos prehospitalarios y hospitalarios, transfusiones, intervenciones quirúrgicas/arteriografía iniciales, paradas cardiorrespiratorias y fallecimientos. Los pacientes fueron clasificados en grupos según su ROTEM® inicial: «normal», «hipercoagulabilidad», «hipocoagulabilidad», «hipocoagulabilidad+hiperfibrinólisis» e «hiperfibrinólisis aislada».
Se analizaron 123 pacientes. En 32 casos (26%) se objetivó CAT: 15 pacientes presentaron hipocoagulabilidad, 9 hiperfibrinólisis aislada y 8 hipocoagulabilidad+hiperfibrinólisis. El grupo con CAT, respecto al grupo «normal», presentó mayor ISS (23 vs 16; P<0,01), mayor transfusión de hemoderivados (2.5 vs 0; P=0,001), más episodios de PCR (19 vs 1%, P<0,01) y mayor mortalidad (34 vs 5%, P<0,01). El subgrupo con hipocoagulabilidad+hiperfibrinólisis, respecto a los grupos con hipocoagulabilidad o hiperfibrinólisis aislada, presentó mayor ISS (41 vs 25 vs 15, P<0,01), mayor necesidad de arteriografía (62% vs 13% vs 0%, P<0,01) y mortalidad superior (75% vs 33% vs 0%, P=0,05).
El 26% de los enfermos politraumatizados presenta coagulopatía precoz evaluada mediante tromboelastografía, asociada a mayor consumo de hemoderivados y menor supervivencia. El perfil combinado de «hipocoagulabilidad+hiperfibrinólisis» se asocia a mayor gravedad y necesidades superiores de hemoderivados y arteriografía.