Thromboelastogram does not detect pre-injury anticoagulation in acute trauma patients

Jawad T. Ali, Mitchell J. Daley, Nina Vadiei, Zachary Enright, Joseph Nguyen, Sadia Ali, Jayson D. Aydelotte, Pedro G. Teixeira, Thomas B. Coopwood, Carlos V R Brown

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: Thromboelastography (TEG) has been recommended to characterize post-traumatic coagulopathy, yet no study has evaluated the impact of pre-injury anticoagulation (AC) on TEG variables. We hypothesized patients on pre-injury AC have a greater incidence of coagulopathy on TEG compared to those without AC. Methods: This retrospective chart review evaluated all trauma patients admitted to an urban, level one trauma center from February 2011 to September 2014 who received a TEG within the first 24. h. Patients were classified as receiving pre-injury AC or no AC if their documented medications prior to admission included warfarin, dabigatran, or anti-Xa (aXa) inhibitors (apixaban or rivaroxaban). The presence of coagulopathy on TEG or conventional assays was defined by exceeding local laboratory reference standards. Results: A total of 54 patients were included (AC, n = 27 [warfarin n = 13, dabigatran n = 6, aXa inhibitor n = 8] vs. no AC, n = 27). Baseline characteristics were similar between groups, including age (72. ±. 13. years vs. 72. ±. 15; p = 0.85), male gender (70% vs. 74%; p = 0.76) and blunt mechanism of injury (100% vs. 100%; p = 1). There was no difference in the number of patients determined to have coagulopathy on TEG (no AC 11% vs. AC 15%; p = 0.99). Conventional tests, including the international normalized ratio (INR) and activated partial thromboplastin time (aPTT), identified coagulopathy in a high proportion of anti-coagulated patients (no AC 22% vs. AC 85%; p. <. 0.01). Conclusion: TEG has limited clinical utility to evaluate the presence of pre-injury AC. Traditional markers of drug induced coagulopathy should guide reversal decisions.

Original languageEnglish (US)
JournalAmerican Journal of Emergency Medicine
DOIs
StateAccepted/In press - Sep 20 2016

Fingerprint

Thrombelastography
Wounds and Injuries
Warfarin
Nonpenetrating Wounds
International Normalized Ratio
Partial Thromboplastin Time
Trauma Centers
Age Groups
Incidence

Keywords

  • Anticoagulant
  • Dabigatran
  • Rivaroxaban
  • TEG
  • Thromboelastography
  • Warfarin

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Ali, J. T., Daley, M. J., Vadiei, N., Enright, Z., Nguyen, J., Ali, S., ... Brown, C. V. R. (Accepted/In press). Thromboelastogram does not detect pre-injury anticoagulation in acute trauma patients. American Journal of Emergency Medicine. https://doi.org/10.1016/j.ajem.2016.12.061

Thromboelastogram does not detect pre-injury anticoagulation in acute trauma patients. / Ali, Jawad T.; Daley, Mitchell J.; Vadiei, Nina; Enright, Zachary; Nguyen, Joseph; Ali, Sadia; Aydelotte, Jayson D.; Teixeira, Pedro G.; Coopwood, Thomas B.; Brown, Carlos V R.

In: American Journal of Emergency Medicine, 20.09.2016.

Research output: Contribution to journalArticle

Ali, JT, Daley, MJ, Vadiei, N, Enright, Z, Nguyen, J, Ali, S, Aydelotte, JD, Teixeira, PG, Coopwood, TB & Brown, CVR 2016, 'Thromboelastogram does not detect pre-injury anticoagulation in acute trauma patients', American Journal of Emergency Medicine. https://doi.org/10.1016/j.ajem.2016.12.061
Ali, Jawad T. ; Daley, Mitchell J. ; Vadiei, Nina ; Enright, Zachary ; Nguyen, Joseph ; Ali, Sadia ; Aydelotte, Jayson D. ; Teixeira, Pedro G. ; Coopwood, Thomas B. ; Brown, Carlos V R. / Thromboelastogram does not detect pre-injury anticoagulation in acute trauma patients. In: American Journal of Emergency Medicine. 2016.
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abstract = "Purpose: Thromboelastography (TEG) has been recommended to characterize post-traumatic coagulopathy, yet no study has evaluated the impact of pre-injury anticoagulation (AC) on TEG variables. We hypothesized patients on pre-injury AC have a greater incidence of coagulopathy on TEG compared to those without AC. Methods: This retrospective chart review evaluated all trauma patients admitted to an urban, level one trauma center from February 2011 to September 2014 who received a TEG within the first 24. h. Patients were classified as receiving pre-injury AC or no AC if their documented medications prior to admission included warfarin, dabigatran, or anti-Xa (aXa) inhibitors (apixaban or rivaroxaban). The presence of coagulopathy on TEG or conventional assays was defined by exceeding local laboratory reference standards. Results: A total of 54 patients were included (AC, n = 27 [warfarin n = 13, dabigatran n = 6, aXa inhibitor n = 8] vs. no AC, n = 27). Baseline characteristics were similar between groups, including age (72. ±. 13. years vs. 72. ±. 15; p = 0.85), male gender (70{\%} vs. 74{\%}; p = 0.76) and blunt mechanism of injury (100{\%} vs. 100{\%}; p = 1). There was no difference in the number of patients determined to have coagulopathy on TEG (no AC 11{\%} vs. AC 15{\%}; p = 0.99). Conventional tests, including the international normalized ratio (INR) and activated partial thromboplastin time (aPTT), identified coagulopathy in a high proportion of anti-coagulated patients (no AC 22{\%} vs. AC 85{\%}; p. <. 0.01). Conclusion: TEG has limited clinical utility to evaluate the presence of pre-injury AC. Traditional markers of drug induced coagulopathy should guide reversal decisions.",
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AU - Ali, Jawad T.

AU - Daley, Mitchell J.

AU - Vadiei, Nina

AU - Enright, Zachary

AU - Nguyen, Joseph

AU - Ali, Sadia

AU - Aydelotte, Jayson D.

AU - Teixeira, Pedro G.

AU - Coopwood, Thomas B.

AU - Brown, Carlos V R

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N2 - Purpose: Thromboelastography (TEG) has been recommended to characterize post-traumatic coagulopathy, yet no study has evaluated the impact of pre-injury anticoagulation (AC) on TEG variables. We hypothesized patients on pre-injury AC have a greater incidence of coagulopathy on TEG compared to those without AC. Methods: This retrospective chart review evaluated all trauma patients admitted to an urban, level one trauma center from February 2011 to September 2014 who received a TEG within the first 24. h. Patients were classified as receiving pre-injury AC or no AC if their documented medications prior to admission included warfarin, dabigatran, or anti-Xa (aXa) inhibitors (apixaban or rivaroxaban). The presence of coagulopathy on TEG or conventional assays was defined by exceeding local laboratory reference standards. Results: A total of 54 patients were included (AC, n = 27 [warfarin n = 13, dabigatran n = 6, aXa inhibitor n = 8] vs. no AC, n = 27). Baseline characteristics were similar between groups, including age (72. ±. 13. years vs. 72. ±. 15; p = 0.85), male gender (70% vs. 74%; p = 0.76) and blunt mechanism of injury (100% vs. 100%; p = 1). There was no difference in the number of patients determined to have coagulopathy on TEG (no AC 11% vs. AC 15%; p = 0.99). Conventional tests, including the international normalized ratio (INR) and activated partial thromboplastin time (aPTT), identified coagulopathy in a high proportion of anti-coagulated patients (no AC 22% vs. AC 85%; p. <. 0.01). Conclusion: TEG has limited clinical utility to evaluate the presence of pre-injury AC. Traditional markers of drug induced coagulopathy should guide reversal decisions.

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