Semin Thromb Hemost 2010; 36(7): 723-737
DOI: 10.1055/s-0030-1265289
© Thieme Medical Publishers

Coagulation Abnormalities in the Trauma Patient: The Role of Point-of-Care Thromboelastography

Eduardo Gonzalez1 , Fredric M. Pieracci1 , Ernest E. Moore1 , Jeffry L. Kashuk2
  • 1Department of Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, Colorado
  • 2Department of Surgery, Division of Acute Care Surgery, Penn State-Hershey College of Medicine, Hershey, Pennsylvania
Further Information

Publication History

Publication Date:
26 October 2010 (online)

ABSTRACT

Current recommendations for resuscitation of the critically injured patient are limited by a lack of point-of-care (POC) assessment of coagulation status. Accordingly, the potential exists for indiscriminant blood component administration. Furthermore, although thromboembolic events have been described shortly after injury, the time sequence of post-injury coagulation changes is unknown. Our current understanding of hemostasis has shifted from a classic view, in which coagulation was considered a chain of catalytic enzyme reactions, to the cell-based model (CBM), representing the interplay between the cellular and plasma components of clot formation. Thromboelastography (TEG), a time-sensitive dynamic assay of the viscoelastic properties of blood, closely parallels the CBM, permitting timely, goal-directed restoration of hemostasis via POC monitoring of coagulation status. TEG-based therapy allows for goal-directed blood product administration in trauma, with potential avoidance of the complications resulting from overzealous component administration, as well as the ability to monitor post-injury coagulation status and thromboprophylaxis. This overview addresses coagulation status and thromboprophylaxis management in the trauma patient and the emerging role of POC TEG.

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Jeffry L KashukM.D. 

Department of Surgery, Division of Trauma, Acute Care, Critical Care Surgery, Penn State – Hershey Medical Center

500 University Drive, MC H075, Room C5520, Hershey, PA 17033-0850

Email: jkashuk@hmc.psu.edu