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Thromboelastometry-guided haemostatic resuscitation in severely injured patients: a propensity score-matched study

BACKGROUND: To accelerate the diagnosis and treatment of trauma-induced coagulopathy (TIC), viscoelastic haemostatic assays (VHA) are increasingly used worldwide, although their value is still debated, with a recent randomised trial showing no improvement in outcome. The objective of this retrospect...

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Autores principales: David, Jean-Stéphane, James, Arthur, Orion, Maxime, Selves, Agathe, Bonnet, Mélody, Glasman, Pauline, Vacheron, Charles-Hervé, Raux, Mathieu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103518/
https://www.ncbi.nlm.nih.gov/pubmed/37055832
http://dx.doi.org/10.1186/s13054-023-04421-w
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author David, Jean-Stéphane
James, Arthur
Orion, Maxime
Selves, Agathe
Bonnet, Mélody
Glasman, Pauline
Vacheron, Charles-Hervé
Raux, Mathieu
author_facet David, Jean-Stéphane
James, Arthur
Orion, Maxime
Selves, Agathe
Bonnet, Mélody
Glasman, Pauline
Vacheron, Charles-Hervé
Raux, Mathieu
author_sort David, Jean-Stéphane
collection PubMed
description BACKGROUND: To accelerate the diagnosis and treatment of trauma-induced coagulopathy (TIC), viscoelastic haemostatic assays (VHA) are increasingly used worldwide, although their value is still debated, with a recent randomised trial showing no improvement in outcome. The objective of this retrospective study was to compare 2 cohorts of injured patients in which TIC was managed with either a VHA-based algorithm or a conventional coagulation test (CCT)-based algorithm. METHODS: Data were retrieved from 2 registries and patients were included in the study if they received at least 1 unit of red blood cell in the first 24 h after admission. A propensity score, including sex, age, blunt vs. penetrating, systolic blood pressure, GCS, ISS and head AIS, admission lactate and PT(ratio), tranexamic acid administration, was then constructed. Primary outcome was the proportion of subjects who were alive and free of massive transfusion (MT) at 24 h after injury. We also compared the cost for blood products and coagulation factors. RESULTS: From 2012 to 2019, 7250 patients were admitted in the 2 trauma centres, and among these 624 were included in the study (CCT group: 380; VHA group: 244). After propensity score matching, 215 patients remained in each study group without any significant difference in demographics, vital signs, injury severity, or laboratory analysis. At 24 h, more patients were alive and free of MT in the VHA group (162 patients, 75%) as compared to the CCT group (112 patients, 52%; p < 0.01) and fewer patients received MT (32 patients, 15% vs. 91 patients, 42%, p < 0.01). However, no significant difference was observed for mortality at 24 h (odds ratio 0.94, 95% CI 0.59–1.51) or survival at day 28 (odds ratio 0.87, 95% CI 0.58–1.29). Overall cost of blood products and coagulation factors was dramatically reduced in the VHA group as compared to the CCT group (median [interquartile range]: 2357 euros [1108–5020] vs. 4092 euros [2510–5916], p < 0.001). CONCLUSIONS: A VHA-based strategy was associated with an increase of the number of patients alive and free of MT at 24 h together with an important reduction of blood product use and associated costs. However, that did not translate into an improvement in mortality. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-023-04421-w.
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spelling pubmed-101035182023-04-15 Thromboelastometry-guided haemostatic resuscitation in severely injured patients: a propensity score-matched study David, Jean-Stéphane James, Arthur Orion, Maxime Selves, Agathe Bonnet, Mélody Glasman, Pauline Vacheron, Charles-Hervé Raux, Mathieu Crit Care Research BACKGROUND: To accelerate the diagnosis and treatment of trauma-induced coagulopathy (TIC), viscoelastic haemostatic assays (VHA) are increasingly used worldwide, although their value is still debated, with a recent randomised trial showing no improvement in outcome. The objective of this retrospective study was to compare 2 cohorts of injured patients in which TIC was managed with either a VHA-based algorithm or a conventional coagulation test (CCT)-based algorithm. METHODS: Data were retrieved from 2 registries and patients were included in the study if they received at least 1 unit of red blood cell in the first 24 h after admission. A propensity score, including sex, age, blunt vs. penetrating, systolic blood pressure, GCS, ISS and head AIS, admission lactate and PT(ratio), tranexamic acid administration, was then constructed. Primary outcome was the proportion of subjects who were alive and free of massive transfusion (MT) at 24 h after injury. We also compared the cost for blood products and coagulation factors. RESULTS: From 2012 to 2019, 7250 patients were admitted in the 2 trauma centres, and among these 624 were included in the study (CCT group: 380; VHA group: 244). After propensity score matching, 215 patients remained in each study group without any significant difference in demographics, vital signs, injury severity, or laboratory analysis. At 24 h, more patients were alive and free of MT in the VHA group (162 patients, 75%) as compared to the CCT group (112 patients, 52%; p < 0.01) and fewer patients received MT (32 patients, 15% vs. 91 patients, 42%, p < 0.01). However, no significant difference was observed for mortality at 24 h (odds ratio 0.94, 95% CI 0.59–1.51) or survival at day 28 (odds ratio 0.87, 95% CI 0.58–1.29). Overall cost of blood products and coagulation factors was dramatically reduced in the VHA group as compared to the CCT group (median [interquartile range]: 2357 euros [1108–5020] vs. 4092 euros [2510–5916], p < 0.001). CONCLUSIONS: A VHA-based strategy was associated with an increase of the number of patients alive and free of MT at 24 h together with an important reduction of blood product use and associated costs. However, that did not translate into an improvement in mortality. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-023-04421-w. BioMed Central 2023-04-13 /pmc/articles/PMC10103518/ /pubmed/37055832 http://dx.doi.org/10.1186/s13054-023-04421-w Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
David, Jean-Stéphane
James, Arthur
Orion, Maxime
Selves, Agathe
Bonnet, Mélody
Glasman, Pauline
Vacheron, Charles-Hervé
Raux, Mathieu
Thromboelastometry-guided haemostatic resuscitation in severely injured patients: a propensity score-matched study
title Thromboelastometry-guided haemostatic resuscitation in severely injured patients: a propensity score-matched study
title_full Thromboelastometry-guided haemostatic resuscitation in severely injured patients: a propensity score-matched study
title_fullStr Thromboelastometry-guided haemostatic resuscitation in severely injured patients: a propensity score-matched study
title_full_unstemmed Thromboelastometry-guided haemostatic resuscitation in severely injured patients: a propensity score-matched study
title_short Thromboelastometry-guided haemostatic resuscitation in severely injured patients: a propensity score-matched study
title_sort thromboelastometry-guided haemostatic resuscitation in severely injured patients: a propensity score-matched study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103518/
https://www.ncbi.nlm.nih.gov/pubmed/37055832
http://dx.doi.org/10.1186/s13054-023-04421-w
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