Hyperfibrinolysis elicited via thromboelastography predicts mortality in trauma

Area of Science:

• Trauma and Emergency Medicine
• Hematology and Coagulation Disorders
• Diagnostic Technologies

Background:

• Acute coagulopathy of trauma significantly impacts patient outcomes.
• Antifibrinolytic agents have shown promise in improving trauma patient outcomes.
• Thromboelastography (TEG) is a valuable tool for assessing coagulopathy in trauma.

Purpose of the Study:

• To prospectively assess coagulopathy in trauma patients using thromboelastography.
• To identify the incidence and clinical significance of hyperfibrinolysis in trauma patients.
• To evaluate hyperfibrinolysis as a predictor of mortality and transfusion needs.

Main Methods:

• Prospective enrollment of trauma patients meeting highest tier activation criteria.
• Thromboelastography (TEG) performed at multiple time points (admission, +1, +2, +6 hours).
• Hyperfibrinolysis defined as estimated percent lysis ≥15%; patients followed for clinical data and outcomes.

Main Results:

• Hyperfibrinolysis detected in 11.0% of patients, with a mean detection time of 13 minutes.
• Hyperfibrinolysis was a strong predictor of early mortality (OR=25.0, p=0.004), accounting for 53% of early deaths.
• Patients with hyperfibrinolysis had significantly higher rates of massive transfusion (76.9% vs 8.7%) and mortality (in-hospital: 92.3% vs 9.5%).

Conclusions:

• Hyperfibrinolysis occurs in approximately 10% of trauma patients and is a significant predictor of mortality.
• Thromboelastography-guided identification of hyperfibrinolysis is crucial for managing trauma patients.
• Further research into thromboelastography-directed antifibrinolytic therapies is warranted.