Trial reportShock (Augusta, Ga.)2019
TEG Lysis Shutdown Represents Coagulopathy in Bleeding Trauma Patients: Analysis of the PROPPR Cohort.
Trial report in Shock (Augusta, Ga.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers.
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
34 citing papers in PubMed, 90 citations in OpenAlex.
- Long-Term Outcomes of Trauma Patients After Treatment With Prehospital Tranexamic Acid: A Subgroup Analysis From the PATCH-Trauma Trial.Journal of the American College of Emergency Physicians open · 2026Article
- Is "Physiological Lysis" in Viscoelastometry a Plasmin-Mediated Process?Diagnostics (Basel, Switzerland) · 2026Article
- 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
- 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
- The Prognostic Value of D-Dimer Levels for Injury Outcomes in Trauma Patients: A Systematic Review and Meta-Analysis.Bulletin of emergency and trauma · 2025Review
- Hyperfibrinolysis: a crucial phenotypic abnormality of posttraumatic fibrinolytic dysfunction.Research and practice in thrombosis and haemostasis · 2024Article
- Trauma induced coagulopathy is limited to only one out of four shock induced endotheliopathy (SHINE) phenotypes among moderate-severely injured trauma patients: an exploratory analysis.Scandinavian journal of trauma, resuscitation and emergency medicine · 2024Observational
- Revolutionizing trauma care: advancing coagulation management and damage control anesthesia.Anesthesia and pain medicine · 2024Review
- Fibrinogen Fragment X Mediates Endothelial Barrier Disruption via Suppression of VE-Cadherin.The Journal of surgical research · 2024Article
- The Fibrinolytic System and Its Measurement: History, Current Uses and Future Directions for Diagnosis and Treatment.International journal of molecular sciences · 2023Review
- Fibrinolysis Shutdown and Hypofibrinolysis Are Not Synonymous Terms: The Clinical Significance of Differentiating Low Fibrinolytic States.Seminars in thrombosis and hemostasis · 2023Review
- Novel blood derived hemostatic agents for bleeding therapy and prophylaxis.Current opinion in hematology · 2022Review
- Coagulopathy management of multiple injured patients - a comprehensive literature review of the European guideline 2019.EFORT open reviews · 2022Review
- Exploratory Investigation of the Plasma Proteome Associated with the Endotheliopathy of Trauma.International journal of molecular sciences · 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
- Inhalation Injury Is Associated With Endotheliopathy and Abnormal Fibrinolytic Phenotypes in Burn Patients: A Cohort Study.Journal of burn care & research : official publication of the American Burn Association · 2022Article
- Endotheliopathy is Associated with a 24-hour Fibrinolysis Phenotype Described by Low TEG Lysis and High D-Dimer after Trauma: a Secondary Analysis of the PROPPR Study.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2022Article
- Trauma-induced pulmonary thromboembolism: What's update?Chinese journal of traumatology = Zhonghua chuang shang za zhi · 2022Review
- Pathologic Fibrinolysis is More Common in a Rural Trauma Setting.The American surgeon · 2021Article
- Effects of pathogen reduction technology and storage duration on the ability of cryoprecipitate to rescue induced coagulopathies in vitro.Transfusion · 2021Article
Corrections and comments
- Commented on by
- Commented on by
Authors and funding
8 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundThrombelastography (TEG) fibrinolysis shutdown after trauma is associated with increased mortality due to hypercoagulability-associated organ failure. However, a lack of mechanistic data has precluded the development of novel interventions to treat shutdown.
objectivesTo define the pathophysiology of TEG shutdown in severely injured, bleeding patients through secondary analysis of the PROPPR trial.
methodsFibrinolysis was characterized in PROPPR subjects using admission TEG lysis at 30 min (LY30) or plasmin-antiplasmin (PAP) levels. LY30 categories were low (<0.9%), moderate (0.9-2.9%), or high (≥ 3%). PAP was classified as low (<1,500 μg/L), moderate (1,500-20,000 μg/L), or high (>20,000 μg/L). Demographics, outcomes, admission TEG values, platelet count and function, standard coagulation tests, and coagulation proteins were compared.
resultsFive hundred forty-seven patients had TEG data and 549 patients had PAP data available. Low LY30 was associated with reduced platelet count and aggregation, poorer TEG clot formation, prolonged clotting times, and reduced fibrinogen and alpha2 antiplasmin. Compared to moderate PAP, low PAP subjects had similar platelet parameters, TEG values, fibrinogen, and alpha2 antiplasmin, but reduced tPA, and elevated PAI-1. D-Dimer values increased as PAP increased, however patients with low LY30 had elevated D-Dimer compared with moderate LY30 patients. Most low LY30 deaths were due to TBI (45%) and hemorrhage (42%) versus one of each cause (TBI, hemorrhage, MOF) in low PAP patients.
conclusionsLow TEG LY30 does not reflect shutdown of enzymatic fibrinolysis with hypercoagulability, but rather a coagulopathic state of moderate fibrinolysis with fibrinogen consumption and platelet dysfunction that is associated with poor outcomes.
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.