Traumatic Coagulopathy

[Kashuk, Jeffry]

Agree that acidosis,hypothermia and coagulopathy (consumptive and/or dilutional) are the end result of shock/tissue hypoperfusion.... this has been known/realized for some time. A fascinating question is: what is the reason for this early anticoagulation and hyperfibrinolysis? Could it be a mechanism of "protection" from end organ thrombosis?(counter-intuitive if there is a 5-fold increase in mortality).
How do you think we ought to be "re-thinking" our treatment of traumatic coagulopathy? Are you suggesting that conventional Rx regimens may really not be effective? Do different patients manifest different pathways of coagulation disorders? 
JK
Jeffry L. Kashuk, M.D, FACS
Surgery, Trauma, Surgical Critical Care
Denver Health Medical Center
777 Bannock St, MC 0206
Denver, CO 80204
Ph 303-436-6558
Fax 303-436-6572
 

-----Original Message-----
From: Karim Brohi [mailto:karim at trauma.org] 
Sent: Sunday,June 03,2007 5:08 AM
To: 'Trauma & Critical Care mailing list'
Subject: RE: Traumatic Coagulopathy

Claudia

Thanks for the plug! (and sorry for the delay)

In a nutshell, the paper ascribes the acute coagulopathy we previously identified (present on admission in 25% of cases and with a 5-fold associated increase in mortality) as being due to the shocked state and tissue hypoperfusion, and not related to consumption, acidosis or dilution.


Next it characterizes the coagulopathy as a systemic anticoagulation and hyperfibrinolysis, and presents evidence that this is due to systemic activation of protein C in the hypoperfused state.  

Our feeling is that a) this is real, b) shock is the primary determinant of coagulopathy prior to transfusion, c) we probably need to rethink how we treat traumatic coagulopathy and d) this has revealed promising targets for novel therapies.

It's an exciting time for coagulation, transfusion and trauma.  We'll see how things pan out over the next few years.

Thanks again Claudia

Karim

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of claudia
Sent: 25 May 2007 16:56
To: Trauma &amp, Critical Care mailing list
Subject: Traumatic Coagulopathy

Dear listmembers,

I came out from lurking mode to send this  to those who haven´t seen it yet.
I think the study would be greatly complemented by an analysis of thrombin generation in parallel.
But, overall, it is quite original due to the early timing of the testing.

Congratulations from Brazil, Dr Brohi.

Claudia Teles
Hemostasis Lab Coordinator - Lamina Unit at Pro Cardiaco Hospital Rio de Janeiro Diagnosticos da America, Brazil




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