Abstract Number: PB1136
Meeting: ISTH 2020 Congress
Background: The relevance of fibrinolysis in major trauma was highlighted by the CRASH-2 study which demonstrated that early administration of tranexamic acid reduced the risk of death and need for transfusion. The thromboelastogram (TEG) Ly30 parameter has been proposed to stratify patients by fibrinolysis phenotypes. While TEG has some major advantages (point-of-care, whole blood etc.), its sensitivity to fibrinolysis is not optimal. Alternative approaches to assess global fibrinolysis in plasma include the euglobulin clot lysis time (ECLT) or turbidity clot lysis in response to tPA assays (Ilich, RPTH 2020).
Aims: Our aim was to test the predictive capacities of TEG Ly30, as well as ECLT, tPA-mediated CLT, free tPA, and D-dimer for massive transfusion.
Methods: Citrated plasmas from 175 trauma patients collected on admission to the Mayo Clinic Trauma Center were evaluated. All samples were obtained before any antifibrinolytic therapy or transfusion. The critical administration threshold (CAT, defined as the administration >3 red cell units over any 1-hour period, during first 24 hours) was used to define massive transfusion. For 133 of these patients, concurrent whole blood TEG data were available. All 175 samples were tested for ECLT, tPA-mediated clot lysis, as well as D-dimer, free tPA by ELISA.
Results: Of 175 patients, 16 reached CAT criteria. In global assays, ECLT demonstrated the best performance; of 16 CAT individuals, 13 were hyperfibrinolytic by ECLT. The c-statistic (area under the ROC curve) to predict massive transfusion for ECLT was 0.704, compared to TEG Ly30 of 0.493 and 0.503 for the tPA clot lysis time. D-dimer, but not free tPA, demonstrated a good predictive value for massive transfusion, with AUC ROC values 0.720 and 0.572, respectively.
Conclusions: These data suggest that hyperfibrinolysis defined by the ECLT and D-dimer predict the need for massive transfusion, with both assays outperforming TEG in this regard.
To cite this abstract in AMA style:Ilich A, Ferrara M, Kumar V, Henderson M, Jenkins D, Kozar R, Park M, Key NS. Biomarkers of Fibrinolysis Predict the Need for Massive Transfusion in Trauma [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/biomarkers-of-fibrinolysis-predict-the-need-for-massive-transfusion-in-trauma/. Accessed May 18, 2021.
« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/biomarkers-of-fibrinolysis-predict-the-need-for-massive-transfusion-in-trauma/