Thrombelastography and tromboelastometry in assessing coagulopathy in trauma

Area of Science:

• Trauma Hemostasis
• Coagulopathy Diagnostics
• Resuscitation Medicine

Background:

• Hemorrhage causes 30-40% of trauma deaths, with coagulopathy present in 25-35% of patients on admission, increasing morbidity and mortality.
• Traditional plasma-based coagulation tests (RCoT) are increasingly recognized as inadequate for managing acute traumatic coagulopathy.
• Advances in understanding post-traumatic coagulopathy necessitate improved diagnostic tools for effective hemostatic resuscitation.

Purpose of the Study:

• To review the principles and clinical utility of viscoelastic haemostatic assays (VHA) in trauma care.
• To highlight the advantages of VHA over RCoT in identifying and managing traumatic coagulopathy.
• To discuss the current applications, limitations, and future directions of VHA in trauma and massive transfusion.

Main Methods:

• Review of scientific literature on viscoelastic haemostatic assays (VHA) including Thromboelastography (TEG) and Rotation Thromboelastometry (ROTEM).
• Analysis of clinical studies involving approximately 5000 surgical and trauma patients comparing VHA-guided therapy to plasma-based assays.
• Examination of the correlation between VHA findings and the cell-based model of hemostasis.

Main Results:

• Clinical studies demonstrate the benefit of VHA in identifying coagulopathy and guiding therapy in trauma patients compared to RCoT.
• VHA provides a comprehensive analysis of whole blood clot formation, aligning with the cell-based model of hemostasis.
• VHA-guided therapy has shown promise in improving outcomes for exsanguinating trauma patients and those undergoing massive transfusion.

Conclusions:

• Viscoelastic haemostatic assays (VHA) are superior to plasma-based assays for monitoring coagulopathy in trauma.
• VHA facilitates effective hemostatic resuscitation, improving outcomes in critically injured patients.
• Further research into VHA applications and limitations will refine trauma hemostasis management.