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Correction of Coagulopathy in Trauma Haemorrhage – Still Room for Improvement. A Secondary Analysis of the ITACTIC trial

1Queen Mary University of London, London, England, United Kingdom, 2Oslo University Hospital & University of Oslo, Oslo, Oslo, Norway, 3Amsterdam University Medical Centre, Amsterdam, Noord-Holland, Netherlands, 4University of Oxford, Oxford, England, United Kingdom, 5Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Nordrhein-Westfalen, Germany, 6Copenhagen University Hospital, Copenhagen, Hovedstaden, Denmark, 7Oxford University Hospitals/NHS Blood and Transplant, Oxford, England, United Kingdom, 8Centre for Trauma Science, Queen Mary Univeristy of London, UK - Barts Health NHS Trust, London, UK, London, England, United Kingdom, 9Oslo University Hospital & University of Oslo, Amsterdam, Oslo, Norway

Abstract Number: OC 11.5

Meeting: ISTH 2022 Congress

Theme: Acquired Bleeding Disorders » Coagulopathy of Major Bleeding (Trauma, PPH, Vascular/surgical, ECMO, GI bleeding, etc.)

Background: Viscoelastic haemostatic assays (VHAs) have advantages over conventional coagulation tests in terms of speed, sensitivity and ability to direct interventions. However, in the ITACTIC trial, comparing major haemorrhage protocols augmented with VHA or CCT guided intervention, there was no overall outcome benefit observed in the VHA arm, despite patients receiving a greater number of targeted interventions more quickly.

Aims: We aimed to explore the effect of targeted transfusion therapies on coagulation parameters in all patients, and a coagulopathic subgroup in the ITACTIC cohort.

Methods: We analysed a subgroup of ITACTIC patients, co-enrolled into the ACIT observational study of coagulation and inflammation after trauma (REC 16/LO/0004 & 07/Q0603/2). We compared coagulation values at baseline and after 4, 8 and 12 units in the whole cohort and in a subgroup who received at least 8 units of RBCs and were coagulopathic at any time point (defined as EXTEM CA5 < 40mm).

Results: 139 patients met the inclusion criteria. Overall, coagulopathy worsened substantially during bleeding (EXTEM CA5 36mm at baseline vs 28mm at 12units). VHA and CCT tests were closer to normal in survivors and in those who received targeted treatment but were not different between the two ITACTIC trial arms. In the subgroup of coagulopathic patients who received at least 8 RBCs, correction of coagulopathy was achieved in more survivors than non survivors (29% vs 13%). Coagulopathy was not corrected in any patient who received only empiric treatment, while targeted therapy corrected coagulation tests in only 25% of subjects. Correction of coagulopathy was greater in the VHA arm (33% vs 16%), and targeted transfusion therapy was administered earlier in this group (100 mins vs 121 mins).

Conclusion(s): Current treatments for trauma induced coagulopathy are not sufficient to correct coagulopathy in the majority of bleeding trauma patients.

To cite this abstract in AMA style:

Lindsay C, Baksaas-Aasen K, Juffermans N, Curry N, Maegele M, Stensballe J, Stanworth S, Davenport R, Næss P, Gaarder C, Brohi K. Correction of Coagulopathy in Trauma Haemorrhage – Still Room for Improvement. A Secondary Analysis of the ITACTIC trial [abstract]. https://abstracts.isth.org/abstract/correction-of-coagulopathy-in-trauma-haemorrhage-still-room-for-improvement-a-secondary-analysis-of-the-itactic-trial/. Accessed September 27, 2023.

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