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.
Gonzalez
Eduardo
E
Department of Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, Colorado, USA.
Pieracci
Fredric M
FM
Moore
Ernest E
EE
Kashuk
Jeffry L
JL
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