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The incidence and magnitude of fibrinolytic activation in trauma patients

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Published:25th Mar 2020
Background: Trauma is a global disease with over 2.5 million deaths annually from haemorrhage and coagulopathy. Overt hyperfibrinolysis is rare in trauma and associated with massive fatal injuries. Paradoxically, clinical trials suggest a much broader indication for antifibrinolytics. Objective: To determine the incidence and magnitude of fibrinolytic activation in trauma patients and its relationship to clot lysis as measured by thromboelastometry. Methods: Prospective cohort study of 303 consecutive trauma patients admitted between January 2007 and June 2009. Blood was drawn on arrival for thromboelastometry (TEM) and coagulation assays. Follow-up was until hospital discharge or death. TEM hyperfibrinolysis was defined as maximum clot lysis (ML) >15%. Fibrinolytic Activation (FA) measured by plasmin-antiplasmin complex (PAP) and D-dimer levels. Data were collected on demographics, mechanism, severity of injury and baseline vital signs. Outcome Measure(s): 28-day mortality. Secondary: 28-day ventilator-free days and 24-hour transfusion requirement. Results: Only 5% of patients had severe fibrinolysis on TEM, but 57% of patients had evidence of �moderate� fibrinolysis with PAP levels elevated over twice normal (>1500?g/L) without lysis on TEM. TEM only detected clot lysis when PAP levels were increased 30 times normal (p<0.001) and antiplasmin levels were less than 75% of normal. patients with fa had increased 28-day mortality compared with no fa (12% vs 1%, p><0.001), fewer ventilator-free days and longer hospital stay. conclusions: fa occurs in the majority of trauma patients and the magnitude of fa correlates with poor clinical outcome. this was not detected by conventional thromboelastometry, an insensitive measure of endogenous fibrinolytic activity.>

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