Evidence map›Paper›PMID 30402564›Full record

ArticleTrauma surgery & acute care open2018

Laboratory measures of coagulation among trauma patients on NOAs: results of the AAST-MIT.

Leslie M Kobayashi, Alexandra Brito, Galinos Barmparas, Patrick Bosarge, Carlos V Brown, Marko Bukur, Matthew M Carrick, Richard D Catalano, Jan Holly-Nicolas, Kenji Inaba and 13 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Trauma surgery & acute care open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
2.3field-weighted citation impact, top 11% of its field
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.

  1. Guideline
  2. Detection of Acute Traumatic Coagulopathy by Viscoelastic Haemostatic Assays Compared to Standard Laboratory Tests: A Systematic Review.Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie · 2023
    Review
  3. Review
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors at 17 institutions in 1 country.

Leslie M KobayashiDivision of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA.ORCID 0000-0002-9063-0908
Alexandra BritoDepartment of Surgery, University of California San Diego, San Diego, California, USA.
Galinos BarmparasDepartment of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA.
Patrick BosargeDivision of Acute Care Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Carlos V BrownDell Medical School, University of Texas at Austin, Austin, Texas, USA.
Marko BukurDivision of Trauma, Emergency Surgery, and Surgical Critical Care, Surgical Intensive Care Unit Bellevue Hospital Center, New York, USA.
Matthew M CarrickUniversity of North Texas Health Science Center, Fort Worth, Texas, USA.
Richard D CatalanoLoma Linda University Medical Center, Loma Linda, California, USA.
Jan Holly-NicolasDepartment of Surgery, Loma Linda University Medical Center, Loma Linda, California, USA.
Kenji InabaDivision of Trauma & Critical Care, University of Southern California, Los Angeles, California, USA.
Stephen KaminskiDepartment of General Surgery and Surgical Critical Care, Santa Barbara Cottage Hospital, Santa Barbara, California, USA.
Amanda L KleinDepartment of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas, USA.
Tammy KopelmanDivision of Burns, Trauma, and Surgical Critical Care, University of Arizona Medical School-Phoenix Campus, Phoenix, Arizona, USA.
Eric J LeyDepartment of General Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA.
Ericca M MartinezChandler Regional Medical Center, Grand Canyon University, Phoenix, Arizona, USA.
Forrest O MooreDepartment of General Surgery, Trauma and Surgical Critical Care, Chandler Regional Medical Center, University of Arizona College of Medicine, Chandler, Arizona, USA.
Jason MurryDepartment of General Surgery Trauma Services, East Texas Medical Center, Tyler, Texas, USA.
Raminder NirulaDepartment of General Surgery, University of Utah, Salt Lake City, Utah, USA.
Douglas PaulDivision of Trauma, Critical Care and Acute Care Surgery, Kettering Medical Center, Kettering, Ohio, USA.
Jacob QuickDivision of Acute Care Surgery, University of Missouri, Columbia, Missouri, USA.
Omar RiveraDivision of Trauma and Critical Care, University of Southern California, Los Angeles, California, USA.
Martin SchreiberDivision of Trauma, Critical Care & Acute Care Surgery, Oregon Health & Science University, Portland, Oregon, USA.
Raul CoimbraDepartment of General Surgery, Riverside University Health System Medical Center, Loma Linda University School of Medicine, Moreno Valley, California, USA.
Cedars-Sinai Medical Center · USLoma Linda University Medical Center · USThe University of Texas at Austin · USUniversity of Arizona · USUniversity of California San Diego · USUniversity of Southern California · USBellevue Hospital Center · USEast Texas Medical Center · USGrand Canyon University · USKettering Medical Center · USLoma Linda University · USOregon Health & Science University · USSanta Barbara Cottage Hospital · USUniversity of Alabama at Birmingham · USUniversity of Missouri · USUniversity of North Texas · USUniversity of Utah · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWarfarin is associated with poor outcomes after trauma, an effect correlated with elevations in the international normalized ratio (INR). In contrast, the novel oral anticoagulants (NOAs) have no validated laboratory measure to quantify coagulopathy. We sought to determine if use of NOAs was associated with elevated activated partial thromboplastin time (aPTT) or INR levels among trauma patients or increased clotting times on thromboelastography (TEG).

methodsThis was a post-hoc analysis of a prospective observational study across 16 trauma centers. Patients on dabigatran, rivaroxaban, or apixaban were included. Laboratory data were collected at admission and after reversal. Admission labs were compared between medication groups. Traditional measures of coagulopathy were compared with TEG results using Spearman's rank coefficient for correlation. Labs before and after reversal were also analyzed between medication groups.

results182 patients were enrolled between June 2013 and July 2015: 50 on dabigatran, 123 on rivaroxaban, and 34 apixaban. INR values were mildly elevated among patients on dabigatran (median 1.3, IQR 1.1-1.4) and rivaroxaban (median 1.3, IQR 1.1-1.6) compared with apixaban (median 1.1, IQR 1.0-1.2). Patients on dabigatran had slightly higher than normal aPTT values (median 35, IQR 29.8-46.3), whereas those on rivaroxaban and apixaban did not. Fifty patients had TEG results. The median values for R, alpha, MA and lysis were normal for all groups. Prothrombin time (PT) and aPTT had a high correlation in all groups (dabigatran p=0.0005, rivaroxaban p<0.0001, and apixaban p<0.0001). aPTT correlated with the R value on TEG in patients on dabigatran (p=0.0094) and rivaroxaban (p=0.0028) but not apixaban (p=0.2532). Reversal occurred in 14%, 25%, and 18% of dabigatran, rivaroxaban, and apixaban patients, respectively. Both traditional measures of coagulopathy and TEG remained within normal limits after reversal. DISCUSSION: Neither traditional measures of coagulation nor TEG were able to detect coagulopathy in patients on NOAs. LEVEL OF EVIDENCE: Level IV.

Indexed as

anticoagulationcoagulation teststrauma management

Identifiers

PMID30402564
PMCPMC6203140
OpenAlexW2896296125

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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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.