- Trauma
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Usefulness of Rotational Thromboelastometry as a Mortality Predictor of Hyperfibrinolysis in Patients with Severe Trauma
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Ji Soo Kim, Il Jae Wang, Seok Ran Yeom, Suck Ju Cho, Jae Hun Kim, June Pill Seok, Seong Hwa Lee, Byung Gwan Bae, Mun Ki Min
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Acute Crit Care. 2018;33(3):162-169. Published online August 31, 2018
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DOI: https://doi.org/10.4266/acc.2018.00199
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Abstract
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- Background
Hemorrhage is the major cause of traumatic death and the leading cause of preventable death. Hyperfibrinolysis is associated with trauma severity. Viscoelastic hemostatic assays show complete clot formation dynamics. The present study was designed to identify the relationship between hyperfibrinolysis and mortality, metabolic acidosis, and coagulopathy in patients with trauma.
Methods Patients with severe trauma (injury severity score [ISS] of 15 or higher) who were assessed using rotational thromboelastometry (ROTEM) were included in the present study from January 2017 to December 2017. Variables were obtained from the Korea Trauma Database or the medical charts of the patients. To identify whether hyperfibrinolysis is an independent predictor of mortality, univariate and multivariate Cox regression analyses were performed.
Results During the 1-year study period, 190 patients were enrolled. In total, 21 (11.1%) had hyperfibrinolysis according to the ROTEM analysis and 46 (24.2%) died. Patients with hyperfibrinolysis had a higher ISS (P=0.014) and mortality rate (P<0.001) than did those without hyperfibrinolysis. In multivariate Cox analysis, hyperfibrinolysis (hazard ratio [HR], 4.960; 95% confidence interval [CI], 2.447 to 10.053), age (HR, 1.033; 95% CI, 1.013 to 1.055), lactic acid level (HR, 1.085; 95% CI, 1.003 to 1.173), and ISS (HR, 1.037; 95% CI, 1.004 to 1.071) were independent predictors of mortality.
Conclusions Hyperfibrinolysis is associated with increased mortality, worse metabolic acidosis, and severe coagulopathy and is an independent predictor of mortality in patients with trauma.
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Citations
Citations to this article as recorded by
- A comparative analysis of tranexamic acid dosing strategies in traumatic major hemorrhage
Finn Gunn, Rheanna Stevenson, Ateeq Almuwallad, Andrea Rossetto, Paul Vulliamy, Karim Brohi, Ross Davenport Journal of Trauma and Acute Care Surgery.2024; 96(2): 216. CrossRef - A retrospective validation of ROTEM algorithms for detecting hyperfibrinolysis demonstrates poor agreement for prediction of in-hospital mortality and transfusion requirement in a general, non-cardiac, surgical population
Leon Rosebery, Matthew Miller, Peter Loizou, Shir Jing Ho, Keith J. Adkins, Kush Deshpande Thrombosis Research.2023; 229: 170. CrossRef - Questions about COVID-19 associated coagulopathy: possible answers from the viscoelastic tests
Vittorio Pavoni, Lara Gianesello, Maddalena Pazzi, Pietro Dattolo, Domenico Prisco Journal of Clinical Monitoring and Computing.2022; 36(1): 55. CrossRef - Clinical value of early assessment of hyperfibrinolysis by rotational thromboelastometry during postpartum hemorrhage for the prediction of severity of bleeding: A multicenter prospective cohort study in the Netherlands
Marije Tahitu, Paul I. Ramler, Ada Gillissen, Camila Caram‐Deelder, Dacia D. C. A. Henriquez, Moniek P. M. de Maat, Johannes J. Duvekot, Jeroen Eikenboom, Kitty W. M. Bloemenkamp, Thomas van den Akker, Johanna G. van der Bom Acta Obstetricia et Gynecologica Scandinavica.2022; 101(1): 145. CrossRef - ROTEM diagnostic capacity for measuring fibrinolysis in neonatal sepsis
Maria Lampridou, Rozeta Sokou, Andreas G. Tsantes, Martha Theodoraki, Aikaterini Konstantinidi, Georgios Ioakeimidis, Stefanos Bonovas, Marianna Politou, Serena Valsami, Zoe Iliodromiti, Theodora Boutsikou, Nicoletta Iacovidou, Georgios Nikolopoulos, Argi Thrombosis Research.2020; 192: 103. CrossRef - The Immunologic Effect of Early Intravenous Two and Four Gram Bolus Dosing of Tranexamic Acid Compared to Placebo in Patients With Severe Traumatic Bleeding (TAMPITI): A Randomized, Double-Blind, Placebo-Controlled, Single-Center Trial
Philip C. Spinella, Kimberly A. Thomas, Isaiah R. Turnbull, Anja Fuchs, Kelly Bochicchio, Douglas Schuerer, Stacey Reese, Adrian A. Coleoglou Centeno, Christopher B. Horn, Jack Baty, Susan M. Shea, M. Adam Meledeo, Anthony E. Pusateri, Jerrold H. Levy, An Frontiers in Immunology.2020;[Epub] CrossRef
- Hematology
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Recombinant Activated Factor VII as a Second Line Treatment for Postpartum Hemorrhage
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Soon Chang Park, Seok Ran Yeom, Sang Kyoon Han, Young Mo Jo, Hyung Bin Kim
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Korean J Crit Care Med. 2017;32(4):333-339. Published online November 30, 2017
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DOI: https://doi.org/10.4266/kjccm.2016.00787
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9,938
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342
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Abstract
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- Background
Severe or massive postpartum hemorrhage (PPH) has remained a leading cause of maternal mortality for decades across the world and it results in critical obstetric complications. Recombinant activated factor VII (rFVIIa) has emerged as a gold standard adjunctive hemostatic agent for the treatment of life-threatening PPH refractory to conventional therapies although it remains off-licensed for use in PPH. We studied the effects of rFVIIa on coagulopathy, transfusion volume, prognosis, severity change in Korean PPH patients.
Methods A retrospective review of medical records between December 2008 and March 2011 indicating use of rFVIIa in severe PPH was performed. We compared age, rFVIIa treatment, transfusion volume, and Sequential Organ Failure Assessment (SOFA) score at the time of arrival in the emergency department and after 24 hours for patients whose SOFA score was 8 points or higher.
Results Fifteen women with SOFA score of 8 and above participated in this study and eight received rFVIIa administration whereas seven did not. Patients’ mean age was 31.7 ± 7.5 years. There was no statistically significant difference in initial and post-24 hours SOFA scores between patients administered rFVIIa or not. The change in SOFA score between initial presentation and after 24 hours was significantly reduced after rFVIIa administration (P = 0.016).
Conclusions This analysis aimed to support that the administration of rFVIIa can reduce the severity of life-threatening PPH in patients. A rapid decision regarding the administration of rFVIIa is needed for a more favorable outcome in severe PPH patients for whom there is no effective standard treatment.
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Citations
Citations to this article as recorded by
- Role of recombinant factor VIIa in the clinical management of severe postpartum hemorrhage: consensus among European experts
D. Surbek, J. Blatný, M. Wielgos, N. Acs, H. Edwards, O. Erez, J. L. Bartha, H. Madar, F. J. Mercier, D. Schlembach, G. C. Di Renzo The Journal of Maternal-Fetal & Neonatal Medicine.2024;[Epub] CrossRef - Efficacy and Safety Analyses of Recombinant Factor VIIa in Severe Post-Partum Hemorrhage
Camila Caram-Deelder, Hellen McKinnon Edwards, Jarmila A. Zdanowicz, Thomas van den Akker, Camilla Birkegård, Jan Blatný, Johanna G. van der Bom, Giuseppe Colucci, Derek van Duuren, Nan van Geloven, Dacia D. C. A. Henriquez, Marian Knight, Lars Korsholm, Journal of Clinical Medicine.2024; 13(9): 2656. CrossRef - Coagulation management and transfusion in massive postpartum hemorrhage
Christina Massoth, Manuel Wenk, Patrick Meybohm, Peter Kranke Current Opinion in Anaesthesiology.2023; 36(3): 281. CrossRef - Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care
Sibylle Kietaibl, Aamer Ahmed, Arash Afshari, Pierre Albaladejo, Cesar Aldecoa, Giedrius Barauskas, Edoardo De Robertis, David Faraoni, Daniela C. Filipescu, Dietmar Fries, Anne Godier, Thorsten Haas, Matthias Jacob, Marcus D. Lancé, Juan V. Llau, Jens Me European Journal of Anaesthesiology.2023; 40(4): 226. CrossRef
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