Tissue plasminogen activator challenge thrombelastography is the most accurate assay in predicting the need for massive transfusion in hypotensive trauma patients

Tissue plasminogen activator (tPA) added to thrombelastography (TEG) detects hyperfibrinolysis by measuring clot lysis at 30 min (tPA-challenge-TEG). We hypothesize that tPA-challenge-TEG is a better predictor of massive transfusion (MT) than existing strategies in trauma patients with hypotension....

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Bibliographic Details
Published in:The American journal of surgery 2023-12, Vol.226 (6), p.778-783
Main Authors: Jiang, Jessie G., Moore, Hunter B., Moore, Ernest E., Pieracci, Fredric, Sauaia, Angela
Format: Article
Language:English
Subjects:
Blood pressure
Coagulopathy
Emergency medical care
Heart rate
Hemorrhagic shock
Hospitals
Hypotension
Laboratories
Lysis
Massive transfusion
Patients
Performance prediction
Resuscitation
Statistical analysis
Subgroups
t-Plasminogen activator
Thrombelastography
Transfusion
Trauma
Trauma centers
Variables
Viscoelasticity
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Summary:Tissue plasminogen activator (tPA) added to thrombelastography (TEG) detects hyperfibrinolysis by measuring clot lysis at 30 min (tPA-challenge-TEG). We hypothesize that tPA-challenge-TEG is a better predictor of massive transfusion (MT) than existing strategies in trauma patients with hypotension. Trauma activation patients (TAP, 2014–2020) with 1) systolic blood pressure 10 RBC U/6H postinjury or death within 6H after ≥1 RBC unit. Area under the receiver operating characteristics curves were used to compare predictive performance. Youden index determined optimal cutoffs. tPA-challenge-TEG was the best predictor of MT in the early hypotension subgroup (N = 212) with positive (PPV) and negative predictive values (NPV) of 75.0%, and 77.6%, respectively. tPA-challenge-TEG was a better predictor of MT than all but TASH (PPV = 65.0%, NPV = 93.3%) in the delayed hypotension group (N = 125). The tPA-challenge-TEG is the most accurate predictor of MT in trauma patients arriving hypotensive and offers early recognition of MT in patients with delayed hypotension. •tPA-challenge TEG LY30 predicts massive transfusion in hypotensive patients.•tPA-TEG LY30 predicts massive transfusion in delayed traumatic hemorrhagic shock.•75% of patients with tPA-challenge-TEG LY30 > 60.6% will require massive transfusion.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2023.05.033