Thromboelastogram does not detect pre-injury anticoagulation in acute trauma patients

Area of Science:

• Trauma Care
• Coagulation Medicine
• Diagnostic Testing

Background:

• Thromboelastography (TEG) is recommended for post-traumatic coagulopathy.
• The impact of pre-injury anticoagulation (AC) on TEG variables remains unevaluated.
• This study investigates the relationship between pre-injury AC and TEG findings in trauma patients.

Purpose of the Study:

• To evaluate the impact of pre-injury anticoagulation on TEG variables in trauma patients.
• To test the hypothesis that patients on pre-injury AC have a higher incidence of coagulopathy on TEG compared to those without AC.

Main Methods:

• Retrospective chart review of trauma patients receiving TEG within 24 hours of admission.
• Patients classified into pre-injury AC (warfarin, dabigatran, anti-Xa inhibitors) or no AC groups.
• Coagulopathy defined by exceeding local laboratory reference standards on TEG or conventional assays.

Main Results:

• No significant difference in TEG-defined coagulopathy between AC (15%) and no AC (11%) groups (p=0.99).
• Conventional assays (INR, aPTT) identified coagulopathy in 85% of AC patients versus 22% of no AC patients (p<0.01).
• Baseline characteristics were similar between the 27 AC and 27 no AC patients.

Conclusions:

• Thromboelastography has limited clinical utility for assessing pre-injury anticoagulation status in trauma.
• Traditional coagulation assays are more effective in identifying drug-induced coagulopathy.
• Traditional markers should guide anticoagulant reversal decisions in trauma patients.