Document Type : Research articles
Authors
1 ataturk sanatoryum training and education hospital
2 University of Health Sciences, Mehmet Akif ?nan Research and Training Hospital, Department of Anesthesiology and Reanimation-Critical Care, Sanliurfa, Turkey
3 Y?ld?r?m Beyaz?t University, School of Medicine, Department of Anesthesiology and Reanimation-Critical Care, Ankara, Turkey
Abstract
Background: Post traumatic coagulopathy is a frequently encountered problem. However, risk factors related to coagulopathy are not exactly known.
Objectives: In this study it is targeted to determine the frequency of coagulopathy related to trauma, risk factors and its affect to prognosis on patients admitted to Intensive Care Unit(ICU) after trauma retrospectively.Methods: 184 patients admitted to mixed type adult ICU, which is having 20 beds, in the years between 2011 and 2017 due to trauma have been studied. Patients have been separated into two groups as patients having coagulopathy and not having coagulopathy by examining their laboratory results. Patients having; thrombocyte count <100 000/?L on the first and third days, Prothrombin Time(PT)>16s, activated Partial Thromboplastine Time(aPTT)>40s, International Normalized Ratio(INR)>1.6 are being accepted as having coagulopathy. Medical records of patients have been recorded retrospectively.Results: The average age of 184 patients that are included in the study is 41.77; 19% of them are Female and 81% of them are Male. Coagulopathy detected on 78 patients (42.4%) (on the first day 32.6%, on the third day 9.8%). It has been detected that, patients developed coagulopathy were having more accompanying diseases(p<0.05), lower Glasgow Coma Score (GCS)(p<0.05), lower albumin values(p<0.05) and higher 28-day mortality rates(p<0.001) compared to patients that have not developed coagulopathy. Revised Trauma Score(RTS) of two groups are not significant(p>0.05). Having accompanying diseases, having low GCS and albumin values are being determined as independent risk factors in coagulopathy development.Conclusion: As a conclusion; since it is not possible to change GCS and risk factors belong to critical trauma patients, we think that it is possible to decrease the frequency of coagulopathy development as well as mortality rate by preventing risk factors such as hypoalbuminemia by means of suitable approaches.
Keywords
- Mitra B, Cameron Pa, Mori A, Fitzgerald M. Acute coagulopathy and early deaths post major trauma. Injury. 2012;43:22-5.
- Brohi K, Singh J, Heron M, et al: Acute traumatic coagulopathy. J Trauma 2003, 54:1127–30.
- Brohi K, Cohen MJ, Ganter MT, et al: Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway? Ann Surg 2007, 245:812–8.
- Maegele M, Lefering R, Yucel N, et al: Early coagulopathy in multiple injury: an analysis from the German trauma registry on 8724 patients. Injury 2007, 38:298–304.
- Schreiber MA: Damage control surgery. Crit Care Clin 2004, 20:101–118.
- Hess J, Brohi K, Dutton R, et al.: The coagulopathy of trauma: a review of mechanisms. J Trauma 2008; 65: 748–54.
- Wafaisade A, Wutzler S, Lefering R, et al.: Drivers of acute coagulopathy after severe trauma: a multivariate analysis of 1987 patients. Emerg Med J 2010; 27: 934–9.
- Spahn D, Rossaint R: Coagulopathy and blood component transfusion in trauma. Br J Anaesth 2005: 95: 130–9.
- Jana B. A. Mac Leod, MD, MSc Mauricio Lynn, et al.: Early Coagulopathy Predicts Mortality in Trauma J Trauma. 2003;55:39–44.
- Floccard B, Rugeri L, Faure A, Saint Denis M, Boyle EM, Peguet O, et al. Early coagulopathy in trauma patients: an on scene and hospital admission study. Injury. 2012;43:26-32.
- Hojjat Derakhshanfar, Ali Vafaei, Ali Tabatabaey, Shamila Noori. Prevalence and Associated Factors of Acute Traumatic Coagulopathy; a Cross Sectional Study. Emergency. 2017;5(1),e58
- Maegele M, Paffrath T, Bouillon B. Acute traumatic coagulopathy in severe injury: incidence, risk stratification, and treatment options. Deutsches Arzteblatt international. 2011;108:827-35.
- MitraB, Cameron PA, MoriA, MainiA, Fitzgerald M,Paul E, et al. Early prediction of acute traumatic coagulopathy. Resuscitation. 2011;82(9):1208-13.
- Mujuni E, Wangoda R, Ongom P, Galukande M. Acute traumatic coagulopathy among major trauma patients in an urban tertiary hospital in sub Saharan Africa. BMC Emerg Med. 2012;12:16.
- Marc Maegele, Herbert Schöchl, Tomas Menovsky, Hugues Marechal, et al. Coagulopathy and haemorrhagic progression in traumatic brain injury: advances in mechanisms, diagnosis, and management Lancet Neurol 2017; 16: 630–47
- Weuster M, Bruck A, Lippross S, Menzdorf L, Fitschen-Oestern S, Behrendt P et al (2016) Epidemiology of accidental hypothermia in polytrauma patients: an analysis of 15,230 patients of the TraumaRegister DGU. J Trauma Acute Care Surg 81(5):905–12.
- May AK, Young JS, Butler K, Bassam D, Brady W. Coagulopathy in severe closed head injury: is empiric therapy warranted? Am Surg. 1997;63:233–7.
- Gorgulu A, Demir M, Eliuz K, Cobanoglu S. Prognostic value of haematologic changes in head trauma. Turkish journal of trauma & emergency surgery. 1999;5:194-9.
- MacLeod JB, Winkler AM, McCoy CC, Hillyer CD, Shaz BH. Early trauma induced coagulopathy (ETIC): prevalence across the injury spectrum. Injury. 2014;45(5):910-5.
- Kimura Y1, Kimura S, Sumita S, Yamakage M. Predictors of hypofibrinogenemia in blunt trauma patients on admission. J Anesth. 2015;29(2):242-8
- Jin H, Tang LQ, Pan ZG, Peng N, Wen Q, Tang YQ, Su L. Ten-year retrospective analysis of multiple trauma complicated by pulmonary contusion. Mil Med Res. 2014;1:7.
- Mark J. Midwinter, Tom Woolley. Resuscitation and coagulation in the severely injured trauma patient. Philos Trans R Soc Lond B Biol Sci. 2011; 366(1562): 192–203.
- Adrie C, Monchi M, Laurent I, Um S, Yan SB et al . Coagulopathy after successful cardiopulmonary resuscitation following cardiac arrest: implication of the protein C anticoagulant pathway. J Am Coll Cardiol. 2005;46(1):21-8.
- Ithan D. Peltan, Ali Rowhani-Rahbar, Lisa K. Vande Vusse, Ellen Caldwell et al. Development and validation of a prehospital prediction model for acute traumatic coagulopathy Critical Care 2016;20:371.
- Donat R. Spahn, Bertil Bouillon, Vladimir Cerny, Jacques Duranteau, Daniela Filipescu, Beverley J. Hunt et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Critical Care 2019;23:98.
- Liu CC, Wang CY, Shih HC, Wen YS, Wu JJ, Huang CI, Hsu HS, Huang MH, Huang MS. Prognostic factors for mortality following falls from height. Injury. 2009;40(6):595–7.
- Frakes MA, Evans T. Major pelvic fractures. Crit Care Nurse. 2004;24(2):18–30.
- Grotz MR, Gummerson NW, Gansslen A, Petrowsky H, Keel M, Allami MK, Tzioupis C, Trentz O, Krettek C, Pape HC, et al. Staged management and outcome of combined pelvic and liver trauma. An international experience of the deadly duo. Injury. 2006;37(7):642–51.
- Wenjun Z. Martini Coagulation complications following trauma. Medical Research. 2016;3:35.
- Sung J, Bochicchio GV, Joshi M, Bochicchio K, Costas A, Tracy K, Scalea TM. Admission serum albumin is predicitve of outcome in critically ill trauma patients. Am Surg. 2004;70(12):1099-102.
- T Garwe, RM Albrecht, JA Stoner, S Mitchell and P Motghare. Hypoalbuminemia at admission is associated with increased incidence of in-hospital complications in geriatric trauma patients Am J Surg. 2016; 212(1):109–15.
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