title: Activated clotting time of thrombelastography (T-ACT) predicts early postinjury blood component transfusion beyond plasma.
abstract: BACKGROUND
  Rapid thrombelastography (rTEG) has been advocated as a point-of-care test to manage trauma-induced coagulopathy. rTEG activated clotting time (T-ACT) results become available much sooner than other rTEG values, thus offering an attractive tool to guide blood component transfusion in a hemorrhagic shock. We hypothesize that patients with a prolonged T-ACT require replacement of platelets (Plts) and cryoprecipitate (Cryo) in addition to plasma to correct trauma-induced coagulopathy.
  
  
  METHODS
  A prospective trauma registry was reviewed for patients with an r-TEG available within 3 hours of injury. Blood was collected via a standardized protocol for rTEG. Patients were stratified into quartiles: low (T-ACT <113 seconds), mild (T-ACT 113-120 seconds), moderate (T-ACT 121-140 seconds), and severe (T-ACT >140 seconds). Transfusion requirements were evaluated during the first 6 hours after injury.
  
  
  RESULTS
  A total of 114 patients were included. Median age was 39 years, injury severity score 20, base-deficit 10, and mortality rate 13%. T-ACT cohorts had similar age (P = .11), injury severity score (P = .55), and base deficit (P = .38). An T-ACT >140 seconds predicted a lower angle (median 57 vs 70, P < .000) and maximum amplitude (46 vs 60, P = .002), and patients received more Cryo (0.5 vs 0, P ≤ .000) and Plts (1 vs 0, P = .006).
  
  
  CONCLUSIONS
  Injured patients requiring resuscitation with blood transfusion that have a T-ACT >140 seconds are polycoagulopathic and may benefit from early Cryo and Plts.
authors.affiliation: University of Colorado, Aurora, CO. Electronic address: hunter.moore@ucdenver.edu.
authors.forename: Hunter B
authors.initials: HB
authors.lastname: Moore
authors.affiliation: University of Colorado, Aurora, CO; Denver Health Medical Center, Denver, CO.
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.affiliation: University of Colorado, Aurora, CO.
authors.forename: Theresa L
authors.initials: TL
authors.lastname: Chin
authors.affiliation: University of Colorado, Aurora, CO.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gonzalez
authors.affiliation: University of Colorado, Aurora, CO.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Chapman
authors.affiliation: University of Colorado, Aurora, CO.
authors.forename: Carson B
authors.initials: CB
authors.lastname: Walker
authors.affiliation: University of Colorado, Aurora, CO.
authors.forename: Angela
authors.initials: A
authors.lastname: Sauaia
authors.affiliation: University of Colorado, Aurora, CO.
authors.forename: Anirban
authors.initials: A
authors.lastname: Banerjee
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000097:blood* / Q000209:etiology / Q000628:therapy*; D016913:Blood Component Transfusion / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010949:Plasma; D017713:Platelet Transfusion; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012151:Resuscitation; D013916:Thrombelastography / Q000379:methods*; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications