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.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/utility-of-lysis-time-global-fibrinolytic-capacity-assay-for-detection-of-hyperfibrinolysis-in-trauma/