Thrombin Generation Kinetics are Predictive of Rapid Transfusion in Trauma Patients Meeting Critical Administration Threshold.
Shock
; 55(3): 321-325, 2021 03 01.
Article
em En
| MEDLINE
| ID: mdl-32826809
ABSTRACT
INTRODUCTION:
We hypothesize that a patient (pt) with accelerated thrombin generation, time to peak height (ttPeak), will have a greater odds of meeting critical administration threshold (CAT) criteria (> 3 packed red blood cell [pRBC] transfusions [Tx] per 60 min interval), within the first 24âh after injury, independent of international normalized ratio (INR).METHODS:
In a prospective cohort study, trauma patients were enrolled over a 4.5-year period and serial blood samples collected at various time points. We retrospectively stratified pts into three categories CAT+, CAT- but receiving some pRBC Tx, receiving no Tx within the first 24âh. Blood collected prior to Tx was analyzed for thrombin generation parameters and prothrombin time (PT)/INR.RESULTS:
A total of 484 trauma pts were analyzed injury severity scoreâ=â13 [7,22], ageâ=â48 [28, 64] years, and 73% male. Fifty pts met criteria for CAT+, 64 pts CAT-, and 370 received no Tx. Risk factors for meeting CAT+ decreased arrival systolic blood pressure (OR 2.82 [2.17, 3.67]), increased INR (OR 2.09, [1.66, 2.62]) and decreased time to peak OR 2.27 [1.74, 2.95]). These variables remained independently associated with increased risk of requiring Tx in a multivariable logistic model, after adjusting for sex and trauma type.CONCLUSIONS:
Pts in hemorrhagic shock, who meet CAT+ criteria, are characterized by accelerated thrombin generation. In our multivariable analysis, both ttPeak and PT/INR have a complementary role in predicting those injured patients who will require a high rate of Tx.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Choque Hemorrágico
/
Transfusão de Sangue
/
Trombina
/
Transfusão de Eritrócitos
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article