Dataset Information

Variations in clot phenotype following injury: The MA-R ratio and fragile clots.

ABSTRACT:

Introduction

Trauma-induced coagulopathy is a continuum ranging from hypercoagulable to hypercoagulable phenotypes. In single-center studies, the maximum amplitude (MA) to r-time (R) (MA-R) ratio has identified a phenotype of injured patients with high mortality risk. The purpose of this study was to determine the relationship between MA-R and mortality using multicenter data and to investigate fibrinogen consumption in the development of this specific coagulopathy phenotype.

Methods

Using the Pragmatic Randomized Optimal Platelet and Plasma Ratios data set, patients were divided into blunt and penetrating injury cohorts. MA was divided by R time from admission thromboelastogram to calculate MA-R. MA-R was used to assess odds of early and late mortality using multivariable models. Multivariable models were used to assess thrombogram values in both cohorts. Refinement of the MA-R cut point was performed with Youden index. Repeat multivariable analysis was performed with a binary CRITICAL and NORMAL MA-R.

Results

In initial analysis, MA-R quartiles were not associated with mortality in the penetrating cohort. In the blunt cohort, there was an association between low MA-R and early and late mortality. A refined cut point of 11 was identified (CRITICAL: MA-R, ≤11; NORMAL: MA-R, >11). CRITICAL MA-R was associated with mortality in both penetrating and blunt subgroups. In further injury subgroup analysis, CRITICAL patients had significantly decreased fibrinogen levels in the blunt subgroup only. In both blunt and penetrating injury, there was no difference in time to initiation of thrombin burst (lagtime). However, both endogenous thrombin potential and peak thrombin levels were significantly lower in CRITICAL patients.

Conclusions

MA-R identifies a trauma-induced coagulopathy phenotype characterized in blunt injury by impaired thrombin generation that is associated with early and late mortality. The endotheliopathy and tissue factor release likely plays a role in the cascade of impaired thrombin burst, possible early fibrinogen consumption and the weaker clot identified by MA-R.

Level of evidence

Therapeutic/care management, level II.

SUBMITTER: Harrington J

PROVIDER: S-EPMC8887779 | biostudies-literature | 2022 Mar

REPOSITORIES: biostudies-literature

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Publications

Variations in clot phenotype following injury: The MA-R ratio and fragile clots.

Harrington James J Zarzaur Ben L BL Fox Erin E EE Wade Charles E CE Holcomb John B JB Savage Stephanie A SA

The journal of trauma and acute care surgery 20220301 3

<h4>Introduction</h4>Trauma-induced coagulopathy is a continuum ranging from hypercoagulable to hypercoagulable phenotypes. In single-center studies, the maximum amplitude (MA) to r-time (R) (MA-R) ratio has identified a phenotype of injured patients with high mortality risk. The purpose of this study was to determine the relationship between MA-R and mortality using multicenter data and to investigate fibrinogen consumption in the development of this specific coagulopathy phenotype.<h4>Methods< ...[more]

PMID: 35196304

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Dataset Information

Variations in clot phenotype following injury: The MA-R ratio and fragile clots.

Introduction

Methods

Results

Conclusions

Level of evidence

Publications

Variations in clot phenotype following injury: The MA-R ratio and fragile clots.

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