ArticleJournal of the American College of Surgeons2021
Whole Blood Thrombin Generation in Severely Injured Patients Requiring Massive Transfusion.
Article in Journal of the American College of Surgeons, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- Inhospital coagulation management and fluid replacement therapy in patients with multiple and/or severe injuries - a systematic review and clinical practice guideline update.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Pooled it
- Trauma-Induced Coagulopathy: From Endotheliopathy and Fibrinolysis Phenotypes to Viscoelastic-Guided Resuscitation.European journal of haematology · 2026Review
- Sonorheometry to detect traumatic induced coagulopathy during initial management of trauma patients: an observational, multi-center study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Observational
- Hemostatic abnormalities after trauma resuscitation: challenges and strategies in caring for the critically injured patient.Annals of intensive care · 2025Review
- Altered thrombin generation with prothrombin complex concentrate is not detected by viscoelastic testing: an in vitro study.British journal of anaesthesia · 2025Article
- Sex dimorphisms in coagulation: Implications in trauma-induced coagulopathy and trauma resuscitation.American journal of hematology · 2024Review
- Peripartum Haemorrhage: Haemostatic Aspects of the Updated Peripartum Haemorrhage Guideline of the German-Speaking Countries.Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie · 2023Review
- Label-free multiplex sensing from buffer and immunoglobulin G sensing from whole blood with photonic crystal slabs using angle-tuning of an optical interference filter.Biomedical optics express · 2023Article
- Severe Trauma-Induced Coagulopathy: Molecular Mechanisms Underlying Critical Illness.International journal of molecular sciences · 2023Review
- Age-dependent thrombin generation predicts 30-day mortality and symptomatic thromboembolism after multiple trauma.Scientific reports · 2023Article
- [The chapters "Stop the bleed-prehospital" and "Coagulation management and volume therapy (emergency departement)" in the new S3 guideline "Polytrauma/severe injury treatment"].Notfall & rettungsmedizin · 2023Review
- Hyperfibrinolysis drives mechanical instabilities in a simulated model of trauma induced coagulopathy.Thrombosis research · 2022Article
- Full-length plasma skeletal muscle myosin isoform deficiency is associated with coagulopathy in acutely injured patients.Journal of thrombosis and haemostasis : JTH · 2022Article
- Emergency Blood Transfusion for Trauma and Perioperative Resuscitation: Standard of Care.Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie · 2021Review
- Trauma-induced coagulopathy.Nature reviews. Disease primers · 2021Review
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundDespite the prevalence of hypocoagulability after injury, the majority of trauma patients paradoxically present with elevated thrombin generation (TG). Although several studies have examined plasma TG post injury, this has not been assessed in whole blood. We hypothesize that whole blood TG is lower in hypocoagulopathy, and TG effectively predicts massive transfusion (MT). STUDY
designBlood was collected from trauma activation patients at an urban Level I trauma center. Whole blood TG was performed with a prototype point-of-care device. Whole blood TG values in healthy volunteers were compared with trauma patients, and TG values were examined in trauma patients with shock and MT requirement.
resultsOverall, 118 patients were included. Compared with healthy volunteers, trauma patients overall presented with more robust TG; however, those arriving in shock (n = 23) had a depressed TG, with significantly lower peak thrombin (88.3 vs 133.0 nM; p = 0.01) and slower maximum rate of TG (27.4 vs 48.3 nM/min; p = 0.04). Patients who required MT (n = 26) had significantly decreased TG, with a longer lag time (median 4.8 vs 3.9 minutes, p = 0.04), decreased peak thrombin (median 71.4 vs 124.2 nM; p = 0.0003), and lower maximum rate of TG (median 15.8 vs 39.4 nM/min; p = 0.01). Area under the receiver operating characteristics (AUROC) analysis revealed lag time (AUROC 0.6), peak thrombin (AUROC 0.7), and maximum rate of TG (AUROC 0.7) predict early MT.
conclusionsThese data challenge the prevailing bias that all trauma patients present with elevated TG and highlight that deficient thrombin contributes to the hypocoagulopathic phenotype of trauma-induced coagulopathy. In addition, whole blood TG predicts MT, suggesting point-of-care whole blood TG can be a useful tool for diagnostic and therapeutic strategies in trauma.
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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 Socratic graph.