ArticleThe journal of trauma and acute care surgery2017
Rapid thrombelastography thresholds for goal-directed resuscitation of patients at risk for massive transfusion.
Article in The journal of trauma and acute care surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04431999 (Evaluation of a Transfusion Therapy Using Whole Blood Versus Fractionated Blood Products in the Management of Coagulopathy in Patients Admitted to Hospital for Acute Traumatic Hemorrhage), which is not on this map. Cited by 42 papers, 3 of them syntheses that pooled it.
What it found
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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.
Evaluation of a Transfusion Therapy Using Whole Blood Versus Fractionated Blood Products in the Management of Coagulopathy in Patients Admitted to Hospital for Acute Traumatic Hemorrhage
Who cites it
42 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition.Critical care (London, England) · 2023Guideline
- Thromboelastography-guided therapy improves patient blood management and certain clinical outcomes in elective cardiac and liver surgery and emergency resuscitation: A systematic review and analysis.Journal of thrombosis and haemostasis : JTH · 2019Pooled it
- The use of viscoelastic haemostatic assays in goal-directing treatment with allogeneic blood products - A systematic review and meta-analysis.Scandinavian journal of trauma, resuscitation and emergency medicine · 2017Pooled it
- Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial.Intensive care medicine · 2021Trial
- Trauma-Induced Coagulopathy: From Endotheliopathy and Fibrinolysis Phenotypes to Viscoelastic-Guided Resuscitation.European journal of haematology · 2026Review
- Blood product supplementation modulates clotting kinetics, mechanics, and fibrin architecture in an in vitro model of trauma-induced coagulopathy.Thrombosis research · 2026Article
- A refined phenomenological model of viscoelastic clot formation and lysis in trauma-induced coagulopathy.Frontiers in cardiovascular medicine · 2026Article
- Viscoelastic Hemostatic Assays in the Management of Trauma-Induced Coagulopathy: A Clinical Update.Journal of clinical medicine · 2025Review
- Clinical evaluation of hypercoagulability in advanced malignant tumors using thromboelastography and conventional coagulation tests.Medicine · 2025Observational
- Multicenter evaluation of the Quantra with the QStat Cartridge in adult trauma patients.Trauma surgery & acute care open · 2025Article
- Traumatic brain injury: Advances in coagulopathy (Review).Biomedical reports · 2024Review
- Update on the pathophysiology and management of acute trauma hemorrhage and trauma-induced coagulopathy based upon viscoelastic testing.Clinical and experimental emergency medicine · 2024Article
- Quick model-based viscoelastic clot strength predictions from blood protein concentrations for cybermedical coagulation control.Nature communications · 2024Article
- Does an early, balanced resuscitation strategy reduce the incidence of hypofibrinogenemia in hemorrhagic shock?Trauma surgery & acute care open · 2024Article
- Perioperative Considerations in Management of the Severely Bleeding Coagulopathic Patient.Anesthesiology · 2023Article
- Full-length plasma skeletal muscle myosin isoform deficiency is associated with coagulopathy in acutely injured patients.Journal of thrombosis and haemostasis : JTH · 2022Article
- Proteomics of Coagulopathy Following Injury Reveals Limitations of Using Laboratory Assessment to Define Trauma-Induced Coagulopathy to Predict Massive Transfusion.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2022Article
- Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices.Journal of clinical medicine · 2022Review
- Do not drink and lyse: alcohol intoxication increases fibrinolysis shutdown in injured patients.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2021Article
- The Pathophysiology and Management of Hemorrhagic Shock in the Polytrauma Patient.Journal of clinical medicine · 2021Review
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
backgroundUncontrolled hemorrhage is a leading cause of mortality after trauma accounting for up to 40% of deaths. Massive transfusion protocols offer a proven benefit in resuscitation of these patients. Recently, the superiority of thrombelastography (TEG)-guided resuscitation over strategies guided by conventional clotting assays has been established. We seek to determine optimal thresholds for rapid (r)-TEG driven resuscitation.
methodsThe r-TEG data were reviewed for 190 patients presenting to our level 1 trauma center from 2010 to 2015. Criteria for inclusion were highest level trauma activation in patients 18 years or older with hypotension presumed due to acute blood loss. Exclusion criteria included isolated gunshot wound to the head, pregnancy, and chronic liver disease. Receiver operating characteristic (ROC) analysis was performed to test the predictive performance of r-TEG for massive transfusion requirement defined by need for (1) >10 units of RBCs total or death in the first 6 hours or (2) >4 units of RBCs in any hour within the first 6 hours. Cutpoint analysis was then performed to determine optimal thresholds for TEG-based resuscitation.
resultsThe ROC analysis of r-TEG yielded areas under the curve (AUC) greater than 70% for all outputs with respect to both transfusion thresholds considered, with exception of activated clotting time and lysis at 30 minutes for greater than 4 U RBC in any hour in the first 6 hours. Optimal cutpoint analysis of the resultant ROC curves was performed and for each value, the most sensitive cutpoint was identified, respectively activated clotting time of 128 seconds or longer, angle (α) of 65 degrees or less, maximum amplitude of 55 mm or less, and lysis at 30 minutes of 5% or greater.
conclusionsThrough ROC analysis of prospective TEG data, we have identified optimal thresholds to guide hemostatic resuscitation. These thresholds should be validated in a prospective multicenter trial. LEVEL OF EVIDENCE: Therapeutic study, level V.
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