Laboratory Assessment of Coagulation

  • Hunter B. Moore
  • Eduardo Gonzalez
  • Ernest E. Moore
Chapter

Abstract

Trauma-induced coagulopathy (TIC) is a multifactorial process associated with increased mortality from hemorrhage, thrombotic complications, and organ failure. TIC represents a spectrum of hyper- and hypocoagulation, which is driven from systemic shock, tissue injury, and reperfusion. These coagulation abnormalities can be related to endothelium, platelets, coagulation factors, fibrinogen, red cells, and neutrophils. The complexity of these interacting systems explains why conventional plasma-based assays are suboptimal in treating coagulopathy following severe injury.

Viscoelastic assays have been used clinically to analyze coagulation abnormalities for over half a century, although interest in their implementation to guide trauma care was not popularized until recently. These assays yield comparable actionable results that would require five conventional coagulation assays and provide results in a clinically relevant time to provide goal-directed resuscitation. These assays also have predictive value for massive transfusion and mortality. Prospective data suggest that viscoelastic-based resuscitation in trauma patients undergoing massive transfusion can reduce mortality by 50%. While multicenter validation of these findings remains to be completed, the benefits of viscoelastic resuscitation are hard to ignore.

The appropriate infrastructure and supporting staff that can run, analyze, and act upon the results of these assays is essential. Implementation of goal-directed resuscitation will undoubtedly be fraught with logistical problems, as the appropriate implementation of massive transfusion protocol already exists as an international problem.

Keywords

TEG ROTEM Viscoelastic assay Massive transfusion Goal-directed resuscitation Trauma Tic Coagulopathy 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Hunter B. Moore
    • 1
  • Eduardo Gonzalez
    • 1
  • Ernest E. Moore
    • 2
    • 3
  1. 1.Department of SurgeryUniversity of ColoradoDenverUSA
  2. 2.Department of Surgery, University of Colorado DenverDenverUSA
  3. 3.Department of Surgery, Denver HealthDenverUSA

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