Trauma, Time, and Transfusions: A Longitudinal Analysis of Coagulation Markers in Severely Injured Trauma Patients Receiving Modified Whole Blood or Component Blood Products.
OBJECTIVE
The current study leveraged data from the Early Whole Blood (EWB) trial to explore the effects of modified whole blood (mWB) versus component (COMP) transfusions on coagulation parameters over time using longitudinal statistical methods.


METHODS
The EWB study was a single-center randomized controlled trial, approved by the local IRB. Adult patients at highest-level trauma activations were randomized into mWB or COMP groups. Coagulation status was evaluated (at times 0, 3, 6, 12, and 24 h postadmission) using thrombelastography, platelet aggregometry, and calibrated automated thrombograms. Longitudinal statistical analyses with generalized estimating equations (GEE) were used to evaluate the effects of group, time, transfusion types, and their respective interactions on changes in measured coagulation markers.


RESULTS
A total of 59 patients were enrolled and adhered to protocol in the EWB trial, 25 in the mWB group, and 34 in the COMP group. Patients in both the mWB and COMP groups demonstrated a significant decline in their thrombelastography parameters during the first 3-6 h, specifically K-time, α-angle, maximum amplitude, G, and LY30. Patients receiving mWB exhibited improved thrombin potential than those receiving COMP. Platelet count and function declined over time in both mWB and COMP groups; however, platelet aggregation in response to ristocetin in the mWB group was significantly improved at 12 h compared with the COMP group. The longitudinal GEE model revealed significant group-time interactive effects on the changes in coagulation markers and significant effect of platelet transfusions on improvements in coagulation profile.


CONCLUSIONS
We observed significant interactive group-time effects, indicating that the types of transfusion as well as the time of transfusion significantly affect the patient's coagulation status. Our pilot data suggest that there is an improvement in platelet function with mWB, but further studies are needed. Regardless, platelet transfusions were associated with improvements in coagulation over time in both the groups.
*Center for Translational Injury Research, Department of Surgery, University of Texas Health Science Center, Houston, Texas †Department of Biomedical Engineering, Wake Forest University, Winston-Salem, North Carolina ‡Department of Surgery, University of California San Francisco, San Francisco, California.
Elaheh
E
Rahbar
Jessica C
JC
Cardenas
Nena
N
Matijevic
Deborah
D
Del Junco
Jeanette
J
Podbielski
Mitchell J
MJ
Cohen
Bryan A
BA
Cotton
John B
JB
Holcomb
Charles E
CE
Wade
D000328:Adult; D001777:Blood Coagulation / Q000502:physiology*; D001779:Blood Coagulation Factors / Q000378:metabolism; D016913:Blood Component Transfusion / Q000379:methods; D001803:Blood Transfusion / Q000379:methods*; D005260:Female; D006487:Hemostasis / Q000502:physiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010979:Platelet Function Tests / Q000379:methods; D013916:Thrombelastography / Q000379:methods; D013917:Thrombin / Q000096:biosynthesis; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000097:blood / Q000628:therapy*
D001779:Blood Coagulation Factors; D013917:Thrombin