ArticleThe journal of trauma and acute care surgery2018
Citrated kaolin thrombelastography (TEG) thresholds for goal-directed therapy in injured patients receiving massive transfusion.
Article in The journal of trauma and acute care surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 citations in OpenAlex.
- Utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients: a systematic review.World journal of emergency surgery : WJES · 2022Pooled it
- Blood product supplementation modulates clotting kinetics, mechanics, and fibrin architecture in an in vitro model of trauma-induced coagulopathy.Thrombosis research · 2026Article
- Trauma-Induced Coagulopathy: A Review of Specific Molecular Mechanisms.Diagnostics (Basel, Switzerland) · 2025Review
- The impact of the patient's plasma volume on the amount of fresh frozen plasma needed to normalize the thromboelastographic reaction time.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Article
- Markers of Futile Resuscitation in Traumatic Hemorrhage: A Review of the Evidence and a Proposal for Futility Time-Outs during Massive Transfusion.Journal of clinical medicine · 2024Review
- Protease-activated receptors and glycoprotein VI cooperatively drive the platelet component in thromboelastography.Journal of thrombosis and haemostasis : JTH · 2023Article
- Review
- Hemorrhagic Resuscitation Guided by Viscoelastography in Far-Forward Combat and Austere Civilian Environments: Goal-Directed Whole-Blood and Blood-Component Therapy Far from the Trauma Center.Journal of clinical medicine · 2022Review
- Role of international normalized ratio in nonpulmonary sepsis screening: An observational study.World journal of clinical cases · 2021Article
- Effects of Blood Components and Whole Blood in a Model of Severe Trauma-Induced Coagulopathy.The Journal of surgical research · 2021Article
- Chinese expert consensus on diagnosis and treatment of coagulation dysfunction in COVID-19.Military Medical Research · 2020Article
- Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China.Military Medical Research · 2020Article
- Multiple electrode aggregometry and thromboelastography in thrombocytopenic patients with haematological malignancies.Blood transfusion = Trasfusione del sangue · 2019Observational
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Authors and funding
11 authors at 1 institution in 2 countries.
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Abstract
introductionGoal-directed hemostatic resuscitation based on thrombelastography (TEG) has a survival benefit compared with conventional coagulation assays such as international normalized ratio, activated partial thromboplastin time, fibrinogen level, and platelet count. While TEG-based transfusion thresholds for patients at risk for massive transfusion (MT) have been defined using rapid TEG, cutoffs have not been defined for TEG using other activators such as kaolin. The purpose of this study was to develop thresholds for blood product transfusion using citrated kaolin TEG (CK-TEG) in patients at risk for MT.
methodsCK-TEG was assessed in trauma activation patients at two Level 1 trauma centers admitted between 2010 and 2017. Receiver operating characteristic (ROC) curve analyses were performed to test the predictive performance of CK-TEG measurements in patients requiring MT, defined as >10 units of red blood cells or death within the first 6 hours. The Youden Index defined optimal thresholds for CK-TEG-based resuscitation.
resultsOf the 825 trauma activations, 671 (81.3%) were men, 419 (50.8%) suffered a blunt injury, and 62 (7.5%) received a MT. Patients who had a MT were more severely injured, had signs of more pronounced shock, and more abnormal coagulation assays. CK-TEG R-time was longer (4.9 vs. 4.4 min, p = 0.0084), angle was lower (66.2 vs. 70.3 degrees, p < 0.0001), maximum amplitude was lower in MT (57 vs. 65.5 mm, p < 0.0001), and LY30 was greater (1.8% vs. 1.2%, p = 0.0012) in patients with MT compared with non-MT. To predict MT, R-time yielded an area under the ROC curve (AUROC) = 0.6002 and a cut point of >4.45 min. Angle had an AUROC = 0.6931 and a cut point of <67 degrees. CMA had an AUROC = 0.7425, and a cut point of <60 mm. LY30 had an AUROC = 0.623 with a cut point of >4.55%.
conclusionWe have identified CK-TEG thresholds that can guide MT in trauma. We propose plasma transfusion for R-time >4.45 min, fibrinogen products for an angle <67 degrees, platelet transfusion for MA <60 mm, and antifibrinolytics for LY30 >4.55%. LEVEL OF EVIDENCE: Therapeutic study, level V.
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