ArticleJournal of the American College of Surgeons2016
Acute Fibrinolysis Shutdown after Injury Occurs Frequently and Increases Mortality: A Multicenter Evaluation of 2,540 Severely Injured Patients.
Article in Journal of the American College of Surgeons, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 109 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
109 citing papers in PubMed, 1 synthesis or guideline pooled it, 289 citations in OpenAlex.
- Guidelines for Enhanced Recovery After Trauma and Intensive Care (ERATIC): Enhanced Recovery After Surgery (ERAS) and International Association for Trauma Surgery and Intensive Care (IATSIC) Society Recommendations: Paper 2: Postoperative and Intensive Care Recommendations.World journal of surgery · 2025Guideline
- Prehospital synergy: Tranexamic acid and blood transfusion in patients at risk for hemorrhage.The journal of trauma and acute care surgery · 2022Trial
- The effect of early tranexamic acid on bleeding, blood product consumption, mortality and length of hospital stay in trauma cases with hemorrhagic shock: a randomized clinical trial.Journal of preventive medicine and hygiene · 2021Trial
- Tranexamic acid administration in the field does not affect admission thromboelastography after traumatic brain injury.The journal of trauma and acute care surgery · 2020Trial
- TEG Lysis Shutdown Represents Coagulopathy in Bleeding Trauma Patients: Analysis of the PROPPR Cohort.Shock (Augusta, Ga.) · 2019Trial
- The hyperfibrinolytic phenotype is the most lethal and resource intense presentation of fibrinolysis in massive transfusion patients.The journal of trauma and acute care surgery · 2018Trial
- Modeling Hemorrhagic Shock in Male SD Rats by Fixed Volume Blood Withdrawal Followed by Partial Resuscitation and Long-Term Outcome Assessment.Medical sciences (Basel, Switzerland) · 2026Article
- Whole blood first resuscitation and association of blood product utilization based on mechanism of injury.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Unique Pattern of Coagulopathy Among Patients With Severe Traumatic Brain Injury: A Principal Component Analysis of Hemorrhagic Shock Trials.Critical care medicine · 2026Article
- Precision hemostasis: how viscoelastic testing guides real-time decision-making in trauma.Trauma surgery & acute care open · 2026Review
- Article
- Poor glycemic control is independently associated with fibrinolysis shutdown in patients with peripheral artery disease.JVS-vascular science · 2026Article
- Viscoelastic Hemostatic Assays in the Management of Trauma-Induced Coagulopathy: A Clinical Update.Journal of clinical medicine · 2025Review
- A Novel Fibrinolysis Resistance Capacity Assay can Detect Fibrinolytic Phenotypes in Trauma Patients.Thrombosis and haemostasis · 2025Article
- Change in novel plasmin activated clotting time assay predicts hyperfibrinolysis, massive transfusion, and mortality in trauma in under 3 minutes.American journal of surgery · 2025Article
- Hemostatic abnormalities after trauma resuscitation: challenges and strategies in caring for the critically injured patient.Annals of intensive care · 2025Review
- Utility of fibrinolysis enhanced viscoelastic assays to evaluate fibrinolysis disorders in critically ill adults with severe infection: a scoping review.Annals of intensive care · 2025Review
- The tissue-plasminogen activator-challenged thromboelastography provides a comprehensive assessment of fibrinolysis in the severely injured.The journal of trauma and acute care surgery · 2025Article
- Rethinking Balanced Resuscitation in Trauma.Journal of clinical medicine · 2025Review
- Rethinking universal anti-fibrinolysis: a randomized controlled trial on divergent fibrinolytic phenotypes in total knee arthroplasty.Burns & trauma · 2025Article
49 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on byDiscussion.2016
Authors and funding
8 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundFibrinolysis is a physiologic process that maintains microvascular patency by breaking down excessive fibrin clot. Hyperfibrinolysis is associated with a doubling of mortality. Fibrinolysis shutdown, an acute impairment of fibrinolysis, has been recognized as a risk factor for increased mortality. The purpose of this study was to assess the incidence and outcomes of fibrinolysis phenotypes in 2 urban trauma centers. STUDY
designInjured patients included in the analysis were admitted between 2010 and 2013, were 18 years of age or older, and had an Injury Severity Score (ISS) > 15. Admission fibrinolysis phenotypes were determined by the clot lysis at 30 minutes (LY30): shutdown ≤ 0.8%, physiologic 0.9% to 2.9%, and hyperfibrinolysis ≥ 3%. Logistic regression was used to adjust for age, arrival blood pressure, ISS, mechanism, and facility.
resultsThere were 2,540 patients who met inclusion criteria. Median age was 39 years (interquartile range [IQR] 26 to 55 years) and median ISS was 25 (IQR 20 to 33), with a mortality rate of 21%. Fibrinolysis shutdown was the most common phenotype (46%) followed by physiologic (36%) and hyperfibrinolysis (18%). Hyperfibrinolysis was associated with the highest death rate (34%), followed by shutdown (22%), and physiologic (14%, p < 0.001). The risk of mortality remained increased for hyperfibrinolysis (odds ratio [OR] 3.3, 95% CI 2.4 to 4.6, p < 0.0001) and shutdown (OR 1.6, 95% CI 1.3 to 2.1, p = 0.0003) compared with physiologic when adjusting for age, ISS, mechanism, head injury, and blood pressure (area under the receiver operating characteristics curve 0.82, 95% CI 0.80 to 0.84).
conclusionsFibrinolysis shutdown is the most common phenotype on admission and is associated with increased mortality. These data provide additional evidence of distinct phenotypes of coagulation impairment and that individualized hemostatic therapy may be required.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.