A prospective study to assess serum level of soluble thrombomodulin as early marker of acute traumatic coagulopathy in polytrauma patients
Keywords:ATC, Serum TM, Polytrauma, Blood transfusion, Lactate
Background: Coagulopathy following major trauma is conventionally attributed to activation of coagulation factors. We hypothesized that early coagulopathy is due to tissue hypoperfusion and investigated thrombomodulin (TM) as early marker of endothelial injury in poly trauma patient.
Methods: This was a prospective cohort study of major trauma patients admitted to a single trauma center. Blood was drawn within 10 minutes of arrival for analysis of TM. We assess its association with blood transfusion, length of hospital stays and mortality.
Results: A total of 90 patients were enrolled. An increasing lactate was associated with high soluble TM. High TM was significantly associated with increased mortality, blood transfusion requirements, hospital stay.
Conclusions: Acute traumatic coagulopathy (ATC) occurs only in the presence of tissue hypoperfusion which we have measured in form of lactate and coagulopathy measured using international normalized ratio (INR) as standard. Admission serum TM can be predictive of clinical outcomes following major trauma.
Gando S, Nanzaki S, Kemmotsu O. Disseminated intravascular coagulation and sustained systemic inflammatory response syndrome predict organ dysfunctions after trauma: application of clinical decision analysis. Ann surg. 1999;229(1):121.
Armand R, Hess JR. Treating coagulopathy in trauma patients. Transfusion med reviews. 2003;17(3):223-31.
Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma Acute Care Surg. 2003;54(6):1127-30.
Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma Acute Care Surg. 2003;55(1):39-44.
Califano F, Giovanniello T, Pantone P, Campana E, Parlapiano C, Alegiani F et al. Clinical importance of thrombomodulin serum levels. Eur review med pharmacol sci. 2000;4:59-66.
Cooper ES, Bracey AW, Horvath AE, Shanberge JN, Simon TL, Yawn DH. Practice parameter for the use of fresh-frozen plasma, cryoprecipitate, and platelets. JAMA. 1994;271(10):777-81.
Rutherford EJ, Morris Jr JA, Reed GW, Hall KS. Base deficit stratifies mortality and determines therapy. J trauma. 1992;33(3):417-23.
Davis JW, Parks SN, Kaups KL, Gladen HE, O'Donnell-Nicol S. Admission base deficit predicts transfusion requirements and risk of complications. J Trauma Acute Care Surg. 1996;41(5):769-74.
Pierrakos C, Vincent JL. Sepsis biomarkers: a review. Cri care. 2010;14(1):1-8.
Okamoto T, Tanigami H, Suzuki K, Shimaoka M. Thrombomodulin: a bifunctional modulator of inflammation and coagulation in sepsis. Crit care res practice. 2012;2012.
Brohi K, Cohen MJ, Ganter MT, Matthay MA, Mackersie RC, Pittet JF. Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway? Ann surg. 2007;245(5):812.
Maegele M. Acute traumatic coagulopathy: Incidence, risk stratification and therapeutic options. World J emergency med. 2010;1(1):12.
Jansen JO, Scarpelini S, Pinto R, Tien HC, Callum J, Rizoli SB. Hypoperfusion in severely injured trauma patients is associated with reduced coagulation factor activity. J Trauma. 2011;71(51):S435-40.
Cohen MJ, Call M, Nelson M, Calfee CS, Esmon CT, Brohi K et al. Critical role of activated protein C in early coagulopathy and later organ failure, infection and death in trauma patients. Ann surg. 2012;255(2):379.
Deras P, Villiet M, Manzanera J, Latry P, Schved JF, Capdevila X et al. Early coagulopathy at hospital admission predicts initial or delayed fibrinogen deficit in severe trauma patients. J Trauma Acute Care Surg. 2014;77(3):433-40.
CRASH-2 Collaborators. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011;377:1096-101.
MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma Acute Care Surg. 2003;55(1):39-44.
Brohi K, Cohen MJ, Davenport RA. Acute coagulopathy of trauma: mechanism, identification and effect. Curr Opin Crit Care. 2007;13(6):680-5.