It's sooner than you think: Blunt solid organ injury patients are already hypercoagulable upon hospital admission - Results of a bi-institutional, prospective study

Am J Surg. 2019 Dec;218(6):1065-1073. doi: 10.1016/j.amjsurg.2019.08.024. Epub 2019 Sep 10.

Abstract

Introduction: The optimal time to initiate venous thromboembolism (VTE) chemoprophylaxis in blunt solid organ injury (BSOI) patients is debated. We hypothesize that 1) BSOI patients are hypercoagulable within 12 h of injury and 2) hypercoagulability dominates in patients who develop clot complications (CC).

Material and methods: This is a prospective study of BSOI patients admitted to two Level-1 Trauma Centers' trauma intensive care units (ICU). Serial kaolin thrombelastography (TEG) and tissue plasminogen activator (tPA)-challenge TEGs were performed. CC included VTE and cerebrovascular accidents.

Results: On ICU admission, all patients (n = 95) were hypercoagulable, 58% were in fibrinolysis shutdown, and 50% of patients were tPA-resistant. Twelve patients (13%) developed CC. Compared to those without CC, they demonstrated decreased fibrinolysis at 12 h and higher clot strength at 48 h CONCLUSIONS: BSOI patients are universally hypercoagulable upon ICU admission. VTE chemoprophylaxis should be started immediately in BSOI patients with hypercoagulability on TEG.

Keywords: Blunt solid organ injury; Hypercoagulability; Thrombelastography; Thrombosis.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Anticoagulants / therapeutic use*
  • Blood Coagulation Disorders / drug therapy*
  • Blood Coagulation Disorders / etiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Thrombelastography
  • Time-to-Treatment
  • Trauma Centers
  • Venous Thromboembolism / prevention & control*
  • Wounds, Nonpenetrating / complications*

Substances

  • Anticoagulants