Clot dynamics and mortality: The MA-R ratio

Area of Science:

• Trauma resuscitation
• Coagulopathy diagnostics
• Thromboelastography applications

Background:

• Traumatic coagulopathy is common, characterized by rapid clot formation and fibrinogen depletion.
• Identifying patients at risk of bleeding diathesis using traditional methods can be challenging.
• Thromboelastography (TEG) offers insights into clot dynamics but requires novel metrics for risk stratification.

Purpose of the Study:

• To develop a single TEG-derived value to assess the risk of traumatic coagulopathy.
• To create a ratio reflecting both hypercoagulable and hypocoagulable states in trauma patients.
• To evaluate the ratio's predictive value for blood product transfusion and mortality.

Main Methods:

• Patients admitted to Level I trauma centers receiving PRBCs within 24 hours were included.
• A novel ratio (MA-R) was calculated by dividing Maximum Amplitude (MA) by R-time from admission TEG.
• Multivariable logistic regression analyzed the association between MA-R quartiles and mortality.

Main Results:

• 330 patients were analyzed; the MA-R ratio was calculated from admission TEG.
• Increasing MA-R ratios correlated with decreased odds of mortality.
• Lowest MA-R ratios were associated with higher Injury Severity Score (ISS) and increased plasma utilization.

Conclusions:

• The MA-R ratio effectively predicts mortality risk in trauma patients.
• This novel metric can identify at-risk individuals early, even without other signs of derangement.
• Low MA-R ratios may guide earlier cryoprecipitate resuscitation over traditional plasma use.