Abstract
Objective. The aim of this study was to identify routinely available clinical surrogate markers for potential clotting factor alterations following multiple trauma. Methods. In 68 patients admitted directly from the scene of the accident, all soluble clotting factors were analyzed and clinical data was collected prospectively. Ten healthy subjects served as control group. Results. Patients showed reduced activities of clotting factors II, V, VII, and X and calcium levels (all P < 0.0001 to 0.01). Levels of hemoglobin and base deficit correlated moderately to highly with the activities of a number of clotting factors. Nonsurvivors and patients who needed preclinical intubation or hemostatic therapy showed significantly reduced factor activities at admission. In contrast, factor VIII activity was markedly elevated after injury in general (P < 0.0001), but reduced in nonsurvivors (P < 0.05). Conclusions. Multiple trauma causes an early reduction of the activities of nearly all soluble clotting factors in general. Initial hemoglobin and, with certain qualifications, base deficit levels demonstrated a potential value in detecting those underlying clotting factor deficiencies. Nevertheless, their role as triggers of a hemostatic therapy as well as the observed response of factor VIII to multiple trauma and also its potential prognostic value needs further evaluation.
Highlights
Multiple trauma is the most common cause of death in adolescence and young adulthood worldwide [1, 2]
Patients showed a mean injury severity score (ISS) of 24 ± 13 points and were admitted to the resuscitation room 63 ± 23 minutes after trauma. 59 patients suffered from blunt trauma, six from isolated traumatic brain injury (TBI), and three from penetrating trauma. 13 patients showed a fatal outcome
The proteolytically activated form of FII, is a crucial protease in the process of coagulation [17], and, in our study the activity of FII was significantly reduced in nonsurvivors
Summary
Multiple trauma is the most common cause of death in adolescence and young adulthood worldwide [1, 2]. Cohen et al, based on a subgroup analysis of data from the PROMMTT-study, demonstrated that clotting factor activities are reduced in coagulopathic major trauma patients receiving blood products [7]. A moderate reduction of clotting factor activities early after severe multiple trauma, irrespective of patient coagulation status, was shown [8]. All studies excluded a considerable number of patients from the final analysis according to certain patient characteristics (e.g., injury severity). We think that those results have to be proven for the majority of multiple trauma patients, as deleterious bleeding disorders are obviously more likely but not limited to certain patient subgroups. In order to achieve clinical benefits from possible findings, reliable and available indicators
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
