Abstract Number: PB0411
Meeting: ISTH 2021 Congress
Background: Rotational thromboelastometry (ROTEM), a viscoelastic assay used for rapid detection of hyperfibrinolysis, has limited sensitivity to identify moderate or low levels of fibrinolytic activation. Injured patients with low/normal levels of EXTEM maximum lysis (ML) have been shown to have biomarker evidence of hyperfibrinolysis with associated poor clinical outcomes.
Aims: To compare the diagnostic performance of global fibrinolytic capacity/lysis time assay (LT) and ROTEM EXTEM ML in detecting fibrinolytic activity, the effect of tranexamic acid (TXA), and whether LT can predict early mortality.
Methods: We performed an exploratory analysis of a prospective cohort of adult trauma patients and healthy donors at a single UK major trauma centre. LT was measured in plasma according to manufacturer’s protocol. Hyperfibrinolysis was defined as ML>15% or LT<=30 minutes and hypofibrinolysis as ML<5% or LT>60 minutes.
Results: Compared to healthy donors (n=19), non-TXA-treated trauma patients (n=60) had evidence of shortened LT indicative of hyperfibrinolysis (median LT: 30 (IQR 26-36) vs 43 (IQR 40-47), p<0.001). All patients who received TXA (n=19) had prolonged LT with complete abolition of fibrinolysis. Only 2 patients had hyperfibrinolysis on ROTEM, both of whom displayed markedly shortened LT. However, 45% (26/58) of the non-TXA-treated patients without overt ROTEM-hyperfibrinolysis had short LT (hyperfibrinolysis), with all observed mortality and massive transfusions occurring in the group with rapid LT but ML low/normal. Only one patient with low ML had prolonged LT (hypofibrinolysis). LT showed increased accuracy compared to ML in predicting 24-hour mortality (AUROC 0.98, 95% CI 0.96-1.00, vs 0.61, 95% CI 0.40-0.81, p=0.001).
Conclusions: This analysis found LT to be superior to ROTEM in identifying hyperfibrinolysis and predicting outcome. Trauma patients were characterised by a shift towards a hyperfibrinolytic state on admission, with hypofibrinolysis an extremely rare occurrence. Future studies to compare LT performance with gold standard biomarkers of fibrinolysis are required.
To cite this abstract in AMA style:Rossetto A, Torres T, Platton S, Vulliamy P, Davenport R. Utility of Lysis Time (Global Fibrinolytic Capacity) Assay for Detection of Hyperfibrinolysis in Trauma [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/utility-of-lysis-time-global-fibrinolytic-capacity-assay-for-detection-of-hyperfibrinolysis-in-trauma/. Accessed December 7, 2021.
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