Early evaluation of acute traumatic coagulopathy by thrombelastography.
The authors performed coagulation monitoring using a viscoelastic point-of-care method on site of the accident and in the emergency department. Prehospital values even before medical intervention detected coagulopathy and correlated with outcome. Hyperfibrinolysis and low fibrinogen were associated with fatalities. Although the approach of prehospital testing is very interesting, methodology of monitoring has several flaws. Tissue factor-activated thromboelastography may not be sufficient in trauma-related bleeding because it does not permit to differentiate defects in fibrin polymerization which, however, have a major pathophysiological importance and clinical relevance for coagulation management. The very expensive and time-consuming Platelet Mapping assay is not validated for measuring fibrinogen concentration and is therefore no alternative to a test measuring functional fibrinogen such as the FIBTEM in rotational thromboelastometry. Platelet Mapping assay has also a limited sensitivity for pharmacological and inherited platelet dysfunctions. Together, the used TEG assays are not sufficient to properly guide coagulation therapy and transfusions but definitely give a better impression of trauma-related coagulopathy compared with routine coagulation tests such as aPTT and PT.
– Sybille Kozek-Langenecker