Features of coagulation hemostasis in patients with polytrauma

Abstract

Background. Post-traumatic coagulopathy develops in 40 % of trauma patients and is the most common cause of death in them. The objective was to study and analyze changes in indicators of coagulation hemostasis, to evaluate the frequency of minor bleedings in patients with polytrauma. Materials and methods. A prospective observational cohort study was conducted among 35 patients with a diagnosis of polytrauma who were treated at the Municipal Non-Profit Enterprise “Lviv First Territorial Medical Association” of the St. Luke’s Hospital, in the anesthesiology unit with intensive care beds, from January 1, 2021 to August 1, 2022. The inclusion in the treatment of tranexamic acid on the first day after polytrauma was evaluated by dividing the obtained data into time intervals: the prehospital stage and the first 3 hours after admission; 3–8 and 8–24 hours after admission for treatment. Coagulation hemostasis was assessed by the international normalized ratio, partial thromboplastin time (PTT), level of total fibrinogen and D-dimers. The occurrence of minor bleedings was determined visually. Research stages: first day (d1), third day (d3) after polytrauma. Results. We studied indicators of coagulation hemostasis: on the first day, there is a significant increase in prothrombin time, a decrease in the prothrombin index and the level of total fibrinogen, an increase in the international normalized ratio and PTT. On the third day after injury, all studied indicators, with the exception of PTT, did not reliably differ from similar indicators of the control group. The level of D-dimers at all stages of the study was higher than normal values. After assessing the frequency of minor bleedings in patients 1–5 days after the injury, it was found that such bleedings were not associated with coagulation disorders. Conclusions. When analyzing the coagulation hemostasis, we have revealed that on the third day after injury, all indicators, except PTT, became normal. It was found that the occurrence of minor bleedings was not associated with coagulation disorders; therefore, they might be associated with vascular and platelet changes or fibrinolytic disorders.