Coagulation abnormalities in the trauma patient: the role of point-of-care thromboelastography.
Current recommendations for resuscitation of the critically injured patient are limited by a lack of point-of-care (POC) assessment of coagulation status. Accordingly, the potential exists for indiscriminant blood component administration. Furthermore, although thromboembolic events have been described shortly after injury, the time sequence of post-injury coagulation changes is unknown. Our current understanding of hemostasis has shifted from a classic view, in which coagulation was considered a chain of catalytic enzyme reactions, to the cell-based model (CBM), representing the interplay between the cellular and plasma components of clot formation. Thromboelastography (TEG), a time-sensitive dynamic assay of the viscoelastic properties of blood, closely parallels the CBM, permitting timely, goal-directed restoration of hemostasis via POC monitoring of coagulation status. TEG-based therapy allows for goal-directed blood product administration in trauma, with potential avoidance of the complications resulting from overzealous component administration, as well as the ability to monitor post-injury coagulation status and thromboprophylaxis. This overview addresses coagulation status and thromboprophylaxis management in the trauma patient and the emerging role of POC TEG.
Department of Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, Colorado, USA.
Eduardo
E
Gonzalez
Fredric M
FM
Pieracci
Ernest E
EE
Moore
Jeffry L
JL
Kashuk
D001778:Blood Coagulation Disorders / Q000097:blood* / Q000209:etiology / Q000473:pathology; D006801:Humans; D019095:Point-of-Care Systems; D013916:Thrombelastography / Q000379:methods*; D014947:Wounds and Injuries / Q000097:blood* / Q000473:pathology