Trial reportAnesthesiology2024
Correction of Trauma-induced Coagulopathy by Goal-directed Therapy: A Secondary Analysis of the ITACTIC Trial.
Trial report in Anesthesiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Trauma-Induced Coagulopathy: From Endotheliopathy and Fibrinolysis Phenotypes to Viscoelastic-Guided Resuscitation.European journal of haematology · 2026Review
- Perioperative Patient Blood Management: Evidence-Based Strategies for Surgeons and Anesthesiologists: A Narrative Review.Journal of clinical medicine · 2026Review
- Multicenter survey on viscoelastic assays access and use in trauma in Swiss emergency departments.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Hemostatic resuscitation in patients with trauma-induced coagulopathy: a narrative review.Acute and critical care · 2026Article
- Precision hemostasis: how viscoelastic testing guides real-time decision-making in trauma.Trauma surgery & acute care open · 2026Review
- Viscoelastic Hemostatic Assays in the Management of Trauma-Induced Coagulopathy: A Clinical Update.Journal of clinical medicine · 2025Review
- Comparison of machine learning and human prediction to identify trauma patients in need of hemorrhage control resuscitation (ShockMatrix study): a prospective observational study.The Lancet regional health. Europe · 2025Article
- Altered thrombin generation with prothrombin complex concentrate is not detected by viscoelastic testing: an in vitro study.British journal of anaesthesia · 2025Article
- Prothrombin time predicting time-dependent and risk-stratified mortality in polytrauma patients.International journal of emergency medicine · 2025Article
Corrections and comments
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Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTrauma hemorrhage induces a coagulopathy with a high associated mortality rate. The Implementing Treatment Algorithms for the Correction of Trauma Induced Coagulopathy (ITACTIC) randomized trial tested two goal-directed treatment algorithms for coagulation management: one guided by conventional coagulation tests and one by viscoelastic hemostatic assays (viscoelastic). The lack of a difference in 28-day mortality led the authors to hypothesize that coagulopathic patients received insufficient treatment to correct coagulopathy.
methodsDuring ITACTIC, two sites were coenrolling patients into an ongoing prospective observational study, which included serial blood sampling at the same intervals as in ITACTIC. The subgroup in both studies had conventional and viscoelastic test results for each patient available for analysis. A goal-directed treatment was defined as one triggered by an ITACTIC algorithm. Coagulopathy was defined as rotational thromboelastometry EXTEM A5 less than 40 mm. The primary outcome was correction of coagulopathy by the 12th unit of erythrocyte transfusion during resuscitation.
resultsFull viscoelastic and conventional coagulation test results were available for 133 patients. Of these patients, 71% were coagulopathic on admission, and 16% developed a coagulopathy during resuscitation. ITACTIC viscoelastic hemostatic assay group patients were more likely to receive goal-directed treatment than the standard group (76% vs. 47%; odds ratio, 3.73; 95% CI, 1.64 to 8.49; P = 0.002). However, only 54% of patients received goal-directed treatment, and only 20% corrected their coagulopathy (vs. 0% with empiric treatment alone; not significant). Median time to first goal-directed treatment was 68 (53 to 88) min for viscoelastic and 110 (77 to 123) min for standard (P = 0.005).
conclusionsIn ITACTIC, many bleeding trauma patients did not receive an indicated goal-directed treatment. Interventions arrived late during resuscitation and were only partially effective at correcting coagulopathy. EDITOR’S PERSPECTIVE:
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