Julia R Coleman1, Annika B Kay2, Ernest E Moore3, Hunter B Moore4, Eduardo Gonzalez5, Sarah Majercik6, Mitchell J Cohen7, Thomas White8, Fredric M Pieracci9. 1. University of Colorado-Denver, Department of Surgery, 12631 E 17th Ave, Aurora, CO, 80045, USA. Electronic address: julia.coleman@cuanschutz.edu. 2. Intermountain Medical Center, Department of Surgery, 5169 S Cottonwood St Ste 400, Murray, UT, 84107, USA. Electronic address: Annika.Kay@imail.org. 3. University of Colorado-Denver, Department of Surgery, 12631 E 17th Ave, Aurora, CO, 80045, USA; Ernest E Moore Shock Trauma Center at Denver Health, Department of Surgery, 777 Bannock St, Denver, CO, 80204, USA. Electronic address: ernest.moore@dhha.org. 4. University of Colorado-Denver, Department of Surgery, 12631 E 17th Ave, Aurora, CO, 80045, USA. Electronic address: hunter.moore@ucdenver.edu. 5. University of Colorado-Denver, Department of Surgery, 12631 E 17th Ave, Aurora, CO, 80045, USA. Electronic address: Eduardo.GonzalezBarreda@nyulangone.org. 6. Intermountain Medical Center, Department of Surgery, 5169 S Cottonwood St Ste 400, Murray, UT, 84107, USA. Electronic address: sarah.majercik@imail.org. 7. University of Colorado-Denver, Department of Surgery, 12631 E 17th Ave, Aurora, CO, 80045, USA; Ernest E Moore Shock Trauma Center at Denver Health, Department of Surgery, 777 Bannock St, Denver, CO, 80204, USA. Electronic address: Mitchell.cohen@dhha.org. 8. Intermountain Medical Center, Department of Surgery, 5169 S Cottonwood St Ste 400, Murray, UT, 84107, USA. Electronic address: tom.white@imail.org. 9. University of Colorado-Denver, Department of Surgery, 12631 E 17th Ave, Aurora, CO, 80045, USA; Ernest E Moore Shock Trauma Center at Denver Health, Department of Surgery, 777 Bannock St, Denver, CO, 80204, USA. Electronic address: Fredric.pieracci@dhha.org.
Abstract
INTRODUCTION: The optimal time to initiate venous thromboembolism (VTE) chemoprophylaxis in blunt solid organ injury (BSOI) patients is debated. We hypothesize that 1) BSOI patients are hypercoagulable within 12 h of injury and 2) hypercoagulability dominates in patients who develop clot complications (CC). MATERIAL AND METHODS: This is a prospective study of BSOI patients admitted to two Level-1 Trauma Centers' trauma intensive care units (ICU). Serial kaolin thrombelastography (TEG) and tissue plasminogen activator (tPA)-challenge TEGs were performed. CC included VTE and cerebrovascular accidents. RESULTS: On ICU admission, all patients (n = 95) were hypercoagulable, 58% were in fibrinolysis shutdown, and 50% of patients were tPA-resistant. Twelve patients (13%) developed CC. Compared to those without CC, they demonstrated decreased fibrinolysis at 12 h and higher clot strength at 48 h CONCLUSIONS: BSOI patients are universally hypercoagulable upon ICU admission. VTE chemoprophylaxis should be started immediately in BSOI patients with hypercoagulability on TEG.
INTRODUCTION: The optimal time to initiate venous thromboembolism (VTE) chemoprophylaxis in blunt solid organ injury (BSOI) patients is debated. We hypothesize that 1) BSOI patients are hypercoagulable within 12 h of injury and 2) hypercoagulability dominates in patients who develop clot complications (CC). MATERIAL AND METHODS: This is a prospective study of BSOI patients admitted to two Level-1 Trauma Centers' trauma intensive care units (ICU). Serial kaolin thrombelastography (TEG) and tissue plasminogen activator (tPA)-challenge TEGs were performed. CC included VTE and cerebrovascular accidents. RESULTS: On ICU admission, all patients (n = 95) were hypercoagulable, 58% were in fibrinolysis shutdown, and 50% of patients were tPA-resistant. Twelve patients (13%) developed CC. Compared to those without CC, they demonstrated decreased fibrinolysis at 12 h and higher clot strength at 48 h CONCLUSIONS: BSOI patients are universally hypercoagulable upon ICU admission. VTE chemoprophylaxis should be started immediately in BSOI patients with hypercoagulability on TEG.
Authors: Julia R Coleman; Ernest E Moore; Michael P Chapman; Anirban Banerjee; Christopher C Silliman; Arsen Ghasabyan; James Chandler; Jason M Samuels; Angela Sauaia Journal: Surgery Date: 2018-06-12 Impact factor: 3.982
Authors: Jeffry L Kashuk; Ernest E Moore; Allison Sabel; Carlton Barnett; James Haenel; Tuan Le; Michael Pezold; Jerry Lawrence; Walter L Biffl; C Clay Cothren; Jeffrey L Johnson Journal: Surgery Date: 2009-10 Impact factor: 3.982
Authors: Nicole A Stassen; Indermeet Bhullar; Julius D Cheng; Marie Crandall; Randall Friese; Oscar Guillamondegui; Randeep Jawa; Adrian Maung; Thomas J Rohs; Ayodele Sangosanya; Kevin Schuster; Mark Seamon; Kathryn M Tchorz; Ben L Zarzuar; Andrew Kerwin Journal: J Trauma Acute Care Surg Date: 2012-11 Impact factor: 3.313
Authors: Patrick B Murphy; Niroshan Sothilingam; Tanya Charyk Stewart; Brandon Batey; Brad Moffat; Daryl K Gray; Neil G Parry; Kelly N Vogt Journal: Can J Surg Date: 2016-04 Impact factor: 2.089
Authors: Ernest E Moore; Hunter B Moore; Lucy Z Kornblith; Matthew D Neal; Maureane Hoffman; Nicola J Mutch; Herbert Schöchl; Beverley J Hunt; Angela Sauaia Journal: Nat Rev Dis Primers Date: 2021-04-29 Impact factor: 65.038
Authors: Franklin L Wright; Thomas O Vogler; Ernest E Moore; Hunter B Moore; Max V Wohlauer; Shane Urban; Trevor L Nydam; Peter K Moore; Robert C McIntyre Journal: J Am Coll Surg Date: 2020-05-15 Impact factor: 6.113
Authors: Eric J Ley; Carlos V R Brown; Ernest E Moore; Jack A Sava; Kimberly Peck; David J Ciesla; Jason L Sperry; Anne G Rizzo; Nelson G Rosen; Karen J Brasel; Rosemary Kozar; Kenji Inaba; Matthew J Martin Journal: J Trauma Acute Care Surg Date: 2020-11 Impact factor: 3.313
Authors: Laura Gillespie; Rashid Z Khan; John E Stillson; Connor M Bunch; Faisal Salim Shariff; Jacob Speybroeck; Anne Grisoli; Meredith Wierman Schmidt; Htay Phyu; Jason Jablonski; Byars Wells; Daniel H Fulkerson; Lyndsay Oancea; Abraham Leiser; Mark Walsh Journal: J Pharm Health Care Sci Date: 2021-04-01
Authors: Joseph F Rappold; Forest R Sheppard; Samuel P Carmichael Ii; Joseph Cuschieri; Eric Ley; Erika Rangel; Anupamaa J Seshadri; Christopher P Michetti Journal: Trauma Surg Acute Care Open Date: 2021-02-24