Prevalence of derangement of coagulation profile in surgical patients and its outcome in India.

Dear Editor,

Patients of trauma surgical emergencies have a deranged coagulation profile at the time of admission, and, if misdiagnosed, the complications are numerous.[1] Prompt and proper identification of the underlying cause of these coagulation abnormalities is required,[2] since each coagulation disorder necessitates very different therapeutic management strategies. In a resource-constraint environment and developing countries, the basic tests for coagulation in practice are prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT).

From June 2013 until September 2013, 100 patients admitted to the surgical emergency unit of the trauma center at KGMU were enrolled into four groups: Group 1 with traumatic brain injury (n = 28), Group 2 with isolated bony polytrauma (n = 27), Group 3 with abdominal surgical emergencies (n = 27), and Group 4 with isolated soft tissue polytrauma (n = 18). Blood samples were taken at admission and at discharge to estimate PT, INR, and aPTT. Secondary outcomes measured included requirement of blood products and hospital stay.

We found that 61% of all patients had deranged PT. This prevalence is much higher than what has been reported in other studies (24–34%).[3456] Patients with soft tissue polytrauma had the highest prevalence of deranged PT, followed in a decreasing order by patients of orthopedic trauma (66.7%), traumatic brain injury (57.1%), and abdominal surgical emergencies (51.9%). Due to the paucity of data in literature regarding the incidence of PT derangement in a group of orthopedic trauma patients, our study puts forward an important result for this issue. The prevalence of derangement in INR was found to be 69.0%, the highest in a bony polytrauma group, followed by soft tissue polytrauma, abdominal surgical emergencies, and traumatic brain injury, in a decreasing order respectively. The prevalence of deranged aPTT was 14.0%, with the highest being abdominal surgical emergencies, followed by bony polytrauma, traumatic brain injury, and soft tissue polytrauma, in a decreasing order respectively. According to a study by Mujuni et al., the prevalence of deranged aPTT was found to be 37% in patients of major trauma, which is much higher than the findings of the present study.[7]

After receiving the treatment, patients of abdominal surgical emergencies and soft tissue polytrauma had the maximum normalization in PT, INR, and aPTT in contrast to patients from groups II and I who failed to show significant improvement in the coagulation profile. Therefore, coagulopathy continued even after treatment in patients of traumatic brain injury and bony polytrauma, which is in accordance with the literature, which states that patients of head injury and major trauma show little improvement after treatment. In terms of blood product used, we found no significant difference in the amount of blood received by each group. In contrast to the above factors, the hospital stay duration showed significant difference among each group, with the patients of traumatic brain injury and abdominal surgical emergencies having the maximum stay.

In conclusion, patients of trauma do experience derangement in their coagulation profiles, and in a developing country like India, simple hematological tests such as PT, INR, and aPTT are of great importance. Coagulation abnormalities observed in patients of isolated bony trauma probably have been reported for the first time in literature.