Trauma Coagulopathy - what values?

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Just to amplify what Tim has said, there's a real problem with using
any lab test to guide therapy because the turn-around time is too long
(30 minutes seems to be the best I've come across) by which time the
patient's physiology has moved on.  Also we'd like to be activating
clotting therapy protocols much earlier than we are currently, so
identifying those patients who are likely to need plasma etc without
wasting buckets of it is difficult. (Hence the interest in
thromboelastometry).

If you're talking about research definitions of TIC/ATC there doesn't
seem to be any real consensus.  Several studies have used >1.5x
normal, but graphs of admission PT/PTT vs blood use or mortality look
linear.  Fibrinogen and platelets appear to be protected early in the
clinical course but decrease with dilution etc.  (Platelet *function*
is another matter entirely!)

Point-of-care devices for PT etc have not been properly validated -
some of them require a certain albumin or haematocrit level to be
accurate - and of course in the bleeding patients this may not be the
case.

K

2009/4/15 Dr Timothy Hardcastle <dr.tchardcastle at absamail.co.za>:
> Cat
>
> This is a difficult one: There is a clinical coagulopathy unrelated to
> specific numbers that is seen to occur with severe trauma. When the
> initial bloods are drawn and the results come back the INR is >1,5, the
> TEG is prolonged / abnormal - (often the first sign) and the platelets
> progressively drop.
>
> The problem is that the lab does the tests at 37'C, so any effect of
> hypotermia is negated, thus giving values that may actually be more normal
> than they truly are. The most important thing is a clinical ooze fromt he
> patient's wounds.
>
> Hope this helps
>
> Tim
> Dr T C Hardcastle
> M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
> Principal Specialist Trauma Surgeon /
> Honorary Lecturer University of KwaZulu-Natal Dept Surgery
> Deputy Director - IALCH Trauma Service
> Durban - South Africa
>> Dear Traumalist
>>
>> What are the values for the current defintion of traumatic coagulopathy?
>>
>> At what values do you consider your trauma-patient coagulopathic, what
>> INR, what platelet, what fibrinogen, what pH?
>>
>> Thanks, Cat
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>
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