Viscoelastic Tissue Plasminogen Activator Challenge Predicts Massive Transfusion in 15 Minutes

Journal of the American College of Surgeons
Hunter B MooreAngela Sauaia

Abstract

Coagulopathy is associated with massive transfusion in trauma, yet most clinical scores to predict this end point do not incorporate coagulation assays. Previous work has identified that shock increases circulating tissue plasminogen activator (tPA). When tPA levels saturate endogenous inhibitors, systemic hyperfibrinolysis can occur. Therefore, the addition of tPA to a patient's blood sample could stratify a patients underlying degree of shock and early coagulation changes to predict progression to massive transfusion. We hypothesized that a modified thrombelastography (TEG) assay with exogenous tPA would unmask patients' impending risk for massive transfusion. Trauma activations were analyzed using rapid TEG and a modified TEG assay with a low and high dose of tPA. Clinical scores (shock index, assessment of blood consumption, and trauma-associated severe hemorrhage) were compared with TEG measurements to predict the need for massive transfusion using areas under the receiver operating characteristic curves. Three hundred and twenty-four patients were analyzed, 17% required massive transfusion. Massive transfusion patients had a median shock index of 1.2, assessment of blood consumption score of 1, and trauma-associated sever...Continue Reading

Citations

Mar 20, 2018·The Journal of Trauma and Acute Care Surgery·Anirban BanerjeeKirk Hansen
Jul 31, 2018·The Journal of Trauma and Acute Care Surgery·Gregory R StettlerAngela Sauaia
Dec 19, 2018·The Journal of Trauma and Acute Care Surgery·Gregory R StettlerAngela Sauaia
Aug 28, 2019·The Journal of Trauma and Acute Care Surgery·Andrew W ShihErik Vu
Jan 13, 2018·Current Opinion in Anaesthesiology·Lewis S Gall, Ross A Davenport
Dec 29, 2018·British Journal of Haematology·Nicola S Curry, Ross Davenport
Jul 16, 2019·Acute Medicine & Surgery·Tawnya VernonChet Morrison
Jun 24, 2020·The Journal of Trauma and Acute Care Surgery·Julia R ColemanKirk Hansen
Sep 18, 2017·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·M J MadurskaJ J Morrison
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Aug 26, 2019·Journal of Emergency Nursing : JEN : Official Publication of the Emergency Department Nurses Association·UNKNOWN 2018 ENA Clinical Practice Guideline CommitteeUNKNOWN Administrative Staff:
May 1, 2021·Nature Reviews. Disease Primers·Ernest E MooreAngela Sauaia
Jun 17, 2021·Veterinary Clinical Pathology·Yekaterina BurikoDeborah C Silverstein
Sep 21, 2021·The Journal of Trauma and Acute Care Surgery·Alexander P MortonChristopher C Silliman

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