Clotting assay predicts need for massive transfusion in trauma patients

Editor's Note

Using a new blood clot strength test based on a modified thrombelastography (TEG) assay with exogenous tissue plasminogen activator (tPA), researchers at the University of Colorado, Denver, were quickly able to assess the overall ability of blood to clot and identify trauma patients in need of a massive blood transfusion in this study.

Of 324 trauma patients analyzed, 17% required a massive transfusion. Combining trauma-associated severe hemorrhage and tPA-TEG variables resulted in a positive prediction of massive transfusion in 49% of patients with a 98% predictive value.

The tPA-TEG assay was completed 30 minutes faster than other tests, and it had improved performance when combined with the conventional international normalized ratio (INR) measurement of blood clotting time.

In the future, these tests, when used in combination, will be able to personalize trauma care, help surgeons save lives, and make better us of scarce blood bank resources, the authors say.

Coagulopathy is associated with massive transfusion in trauma, yet most clinical scores to predict this end point do not incorporate coagulation assays. Previous work has identified that shock increases circulating tissue plasminogen activator (tPA). When tPA levels saturate endogenous inhibitors, systemic hyperfibrinolysis can occur. Therefore, the addition of tPA to a patient's blood sample could stratify a patients underlying degree of shock and early coagulation changes to predict progression to massive transfusion.