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4. Acute respiratory distress syndrome, acute kidney injury, and mortality after trauma are associated with increased circulation of syndecan-1, soluble thrombomodulin, and receptor for advanced glycation end products

Author

Dixon, Alexandra, Kenny, James E., Buzzard, Lydia, Holcomb, John, Bulger, Eileen, Wade, Charles, Fabian, Timothy, Schreiber, Martin, Holcomb, John B., Wade, Charles E., del Junco, Deborah J., Fox, Erin E., Matijevic, Nena, Podbielski, Jeanette M., Beeler, Angela M., Tilley, Barbara C., Baraniuk, Sarah, DeSantis, Stacia M., Zhu, Hongjian, Nixon, Joshua, Seay, Roann, Appana, Savitri N., Yang, Hui, Gonzalez, Michael O., Baer, Lisa, Wang, Yao-Wei Willa, Hula, Brittany S., Espino, Elena, Nguyen, An, Pawelczyk, Nicholas, Arora-Nutall, Kisha D., Sharma, Rishika, Cardenas, Jessica C., Rahbar, Elaheh, Burnett, Tyrone, Jr, Clark, David, van Belle, Gerald, May, Susanne, Leroux, Brian, Hoyt, David, Powell, Judy, Sheehan, Kellie, Hubbard, Alan, Arkin, Adam P., Hess, John R., Callum, Jeannie L., Pittet, Jean-Francois, Miller, Christopher N., Cotton, Bryan A., Vincent, Laura, Welch, Timothy, Poole, Tiffany, Pivalizza, Evan G., Gumbert, Sam D., Bai, Yu, McCarthy, James J., Noland, Amy, Hobbs, Rhonda, Bulger, Eileen M., Klotz, Patricia, Cattin, Lindsay, Warner, Keir J., Wilson, Angela, Boman, David, White, Nathan, Grabinsky, Andreas, Daniel-Johnson, Jennifer A., Cohen, Mitchell Jay, Callcut, Rachael A., Nelson, Mary, Redick, Brittney, Conroy, Amanda, Steurer, Marc P., Maxim, Preston C., Fiebig, Eberhard, Moore, Joanne, Mallari, Eireen, Muskat, Peter, Johannigman, Jay A., Robinson, Bryce R. H., Branson, Richard D., Gomaa, Dina, Barczak, Christopher, Bennett, Suzanne, Carey, Patricia M., Hancock, Helen, Rodriguez, Carolina, Inaba, Kenji, Zhu, Jay G., Wong, Monica D., Menchine, Michael, Katzberg, Kelly, Henderson, Sean O., McKeever, Rodney, Shulman, Ira A., Nelson, Janice M., Tuma, Christopher W., Matsushita, Cheryl Y., Scalea, Thomas M., Stein, Deborah M., Shaffer, Cynthia K., Wade, Christine, Herrera, Anthony V., Kallam, Seeta, Wade, Sarah E., Galvagno, Samuel M., Jr, Fontaine, Magali J., Hunt, Janice M., Cooke, Rhonda K., Fabian, Timothy C., Weinberg, Jordan A., Croce, Martin A., Wilson, Suzanne, Panzer-Baggett, Stephanie, Waddle-Smith, Lynda, Flax, Sherri, Brasel, Karen J., Walsh, Pamela, Milia, David, Nelson, Allia, Kaslow, Olga, Aufderheide, Tom P., Gottschall, Jerome L., Carpenter, Erica, OʼKeeffe, Terence, Rokowski, Laurel L., Denninghoff, Kurt R., Redford, Daniel T., Novak, Deborah J., Knoll, Susan, Kerby, Jeffrey D., Bosarge, Patrick L., Pierce, Albert T., Williams, Carolyn R., Stephens, Shannon W., Wang, Henry E., Marques, Marisa B., Schreiber, Martin A., Watters, Jennifer M., Underwood, Samantha J., Groat, Tahnee, Newgard, Craig, Merkel, Matthias, Scanlan, Richard M., Miller, Beth, Rizoli, Sandro, Tien, Homer, Nascimento, Barto, Trpcic, Sandy, Sobrian-Couroux, Skeeta, Reis, Marciano, Pérez, Adic, Belo, Susan E., Merkley, Lisa, and Colavecchia, Connie

Published
2024
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7. Older Blood Is Associated With Increased Mortality and Adverse Events in Massively Transfused Trauma Patients: Secondary Analysis of the PROPPR Trial

Author

Jones, Allison R, Patel, Rakesh P, Marques, Marisa B, Donnelly, John P, Griffin, Russell L, Pittet, Jean-Francois, Kerby, Jeffrey D, Stephens, Shannon W, DeSantis, Stacia M, Hess, John R, Wang, Henry E, Group, PROPPR Study, Holcomb, John B, Wade, Charles E, del Junco, Deborah J, Fox, Erin E, Matijevic, Nena, Podbielski, Jeanette, Beeler, Angela M, Tilley, Barbara C, Baraniuk, Sarah, Zhu, Hongjian, Nixon, Joshua, Seay, Roann, Appana, Savitri N, Yang, Hui, Gonzalez, Michael O, Baer, Lisa, Wang, Yao-Wei W, Hula, Brittany S, Espino, Elena, Nguyen, An, Pawelczyk, Nicholas, Arora-Nutall, Kisha D, Sharma, Rishika, Cardenas, Jessica C, Rahbar, Elaheh, Burnett, Tyrone, Clark, David, van Belle, Gerald, May, Susanne, Leroux, Brian, Hoyt, David, Powell, Judy, Sheehan, Kellie, Hubbard, Alan, Arkin, Adam P, Callum, Jeanne, Cotton, Bryan A, Vincent, Laura, Welch, Timothy, Poole, Tiffany, Pivalizza, Evan G, Gumbert, Sam D, Bai, Yu, McCarthy, James J, Noland, Amy, Hobbs, Rhonda, Bulger, Eileen M, Klotz, Patricia, Cattin, Lindsay, Warner, Keir J, Wilson, Angela, Boman, David, White, Nathan, Grabinsky, Andreas, Daniel-Johnson, Jennifer A, Cohen, Mitchell J, Callcut, Rachael A, Nelson, Mary, Redick, Brittney, Conroy, Amanda, Steurer, Marc P, Maxim, Preston C, Fiebig, Eberhard, Moore, Joanne, Mallari, Eireen, Muskat, Peter, Johannigman, Jay A, Robinson, Bryce RH, Branson, Richard D, Gomaa, Dina, Barczak, Christopher, Bennett, Suzanne, Carey, Patricia M, Miller, Christopher N, Hancock, Helen, Rodriguez, Carolina, Inaba, Kenji, Zhu, Jay G, Wong, Monica D, Menchine, Michael, Katzberg, Kelly, Henderson, Sean O, McKeever, Rodney, Shulman, Ira A, Nelson, Janice M, Tuma, Christopher W, and Matsushita, Cheryl Y

Subjects
Clinical Research, Clinical Trials and Supportive Activities, Hematology, Physical Injury - Accidents and Adverse Effects, Good Health and Well Being, Adult, Blood Preservation, Blood Transfusion, Critical Illness, Female, Hospital Mortality, Humans, Male, Middle Aged, Odds Ratio, Trauma Centers, PROPPR Study Group, Clinical Sciences, Emergency & Critical Care Medicine
Abstract

Study objectiveThe transfusion of older packed RBCs may be harmful in critically ill patients. We seek to determine the association between packed RBC age and mortality among trauma patients requiring massive packed RBC transfusion.MethodsWe analyzed data from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial. Subjects in the parent trial included critically injured adult patients admitted to 1 of 12 North American Level I trauma centers who received at least 1 unit of packed RBCs and were predicted to require massive blood transfusion. The primary exposure was volume of packed RBC units transfused during the first 24 hours of hospitalization, stratified by packed RBC age category: 0 to 7 days, 8 to 14 days, 15 to 21 days, and greater than or equal to 22 days. The primary outcome was 24-hour mortality. We evaluated the association between transfused volume of each packed RBC age category and 24-hour survival, using random-effects logistic regression, adjusting for total packed RBC volume, patient age, sex, race, mechanism of injury, Injury Severity Score, Revised Trauma Score, clinical site, and trial treatment group.ResultsThe 678 patients included in the analysis received a total of 8,830 packed RBC units. One hundred patients (14.8%) died within the first 24 hours. On multivariable analysis, the number of packed RBCs greater than or equal to 22 days old was independently associated with increased 24-hour mortality (adjusted odds ratio [OR] 1.05 per packed RBC unit; 95% confidence interval [CI] 1.01 to 1.08): OR 0.97 for 0 to 7 days old (95% CI 0.88 to 1.08), OR 1.04 for 8 to 14 days old (95% CI 0.99 to 1.09), and OR 1.02 for 15 to 21 days old (95% CI 0.98 to 1.06). Results of sensitivity analyses were similar only among patients who received greater than or equal to 10 packed RBC units.ConclusionIncreasing quantities of older packed RBCs are associated with increased likelihood of 24-hour mortality in trauma patients receiving massive packed RBC transfusion (≥10 units), but not in those who receive fewer than 10 units.

Published
2019

11. Reply

Author

Pivalizza, Evan G., primary, Swift, Maggie M., additional, and Fair, Jeffrey H., additional

Published
2024
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12. Onset of Coagulation Function Recovery Is Delayed in Severely Injured Trauma Patients with Venous Thromboembolism

Author

McCully, Belinda H, Connelly, Christopher R, Fair, Kelly A, Holcomb, John B, Fox, Erin E, Wade, Charles E, Bulger, Eileen M, Schreiber, Martin A, Group, PROPPR Study, del Junco, Deborah J, Matijevic, Nena, Podbielski, Jeanette, Beeler, Angela M, Tilley, Barbara C, Baraniuk, Sarah, Nixon, Joshua, Seay, Roann, Appana, Savitri N, Yang, Hui, Gonzalez, Michael O, Baer, Lisa, Wang, Yao-Wei Willa, Hula, Brittany S, Espino, Elena, Nguyen, An, Pawelczyk, Nicholas, Arora-Nutall, Kisha D, Sharma, Rishika, Cardenas, Jessica C, Rahbar, Elaheh, Burnett, Tyrone, Clark, David, van Belle, Gerald, May, Susanne, Leroux, Brian, Hoyt, David, Powell, Judy, Sheehan, Kellie, Hubbard, Alan, Arkin, Adam P, Hess, John R, Callum, Jeanne, Cotton, Bryan A, Vincent, Laura, Welch, Timothy, Poole, Tiffany, Pivalizza, Evan G, Gumbert, Sam D, Bai, Yu, McCarthy, James J, Noland, Amy, Hobbs, Rhonda, Klotz, Patricia, Cattin, Lindsay, Warner, Keir J, Wilson, Angela, Boman, David, White, Nathan, Grabinsky, Andreas, Daniel-Johnson, Jennifer A, Cohen, Mitchell Jay, Callcut, Rachael A, Nelson, Mary, Redick, Brittney, Conroy, Amanda, Steurer, Marc P, Maxim, Preston C, Fiebig, Eberhard, Moore, Joanne, Mallari, Eireen, Muskat, Peter, Johannigman, Jay A, Robinson, Bryce RH, Branson, Richard D, Gomaa, Dina, Barczak, Christopher, Bennett, Suzanne, Carey, Patricia M, Miller, Christopher N, Hancock, Helen, Rodriguez, Carolina, Inaba, Kenji, Zhu, Jay G, Wong, Monica D, Menchine, Michael, Katzberg, Kelly, Henderson, Sean O, McKeever, Rodney, Shulman, Ira A, Nelson, Janice M, Tuma, Christopher W, Matsushita, Cheryl Y, Scalea, Thomas M, Stein, Deborah M, Shaffer, Cynthia K, and Wade, Christine

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Physical Injury - Accidents and Adverse Effects, Hematology, Clinical Research, Cardiovascular, Adult, Anticoagulants, Blood Coagulation Disorders, Blood Coagulation Tests, Female, Humans, Injury Severity Score, Male, Middle Aged, Recovery of Function, Thrombelastography, Trauma Centers, Venous Thromboembolism, Wounds and Injuries, PROPPR Study Group, Surgery, Clinical sciences
Abstract

BackgroundAltered coagulation function after trauma can contribute to development of venous thromboembolism (VTE). Severe trauma impairs coagulation function, but the trajectory for recovery is not known. We hypothesized that enhanced, early recovery of coagulation function increases VTE risk in severely injured trauma patients.Study designSecondary analysis was performed on data from the Pragmatic Randomized Optimal Platelet and Plasma Ratio (PROPPR) trial, excluding patients who died within 24 hours or were on pre-injury anticoagulants. Patient characteristics, adverse outcomes, and parameters of platelet function and coagulation (thromboelastography) were compared from admission to 72 hours between VTE (n = 83) and non-VTE (n = 475) patients. A p value < 0.05 indicates significance.ResultsDespite similar patient demographics, VTE patients exhibited hypercoagulable thromboelastography parameters and enhanced platelet function at admission (p < 0.05). Both groups exhibited hypocoagulable thromboelastography parameters, platelet dysfunction, and suppressed clot lysis (low clot lysis at 30 minutes) 2 hours after admission (p < 0.05). The VTE patients exhibited delayed coagulation recovery (a significant change compared with 2 hours) of K-value (48 vs 24 hours), α-angle (no recovery), maximum amplitude (24 vs 12 hours), and clot lysis at 30 minutes (48 vs 12 hours). Platelet function recovery mediated by arachidonic acid (72 vs 4 hours), ADP (72 vs 12 hours), and collagen (48 vs 12 hours) was delayed in VTE patients. The VTE patients had lower mortality (4% vs 13%; p < 0.05), but fewer hospital-free days (0 days [interquartile range 0 to 8 days] vs 10 days [interquartile range 0 to 20 days]; p < 0.05) and higher complication rates (p < 0.05).ConclusionsRecovery from platelet dysfunction and coagulopathy after severe trauma were delayed in VTE patients. Suppressed clot lysis and compensatory mechanisms associated with altered coagulation that can potentiate VTE formation require additional investigation.

Published
2017

18. Elevated Syndecan-1 after Trauma and Risk of Sepsis: A Secondary Analysis of Patients from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial

Author

Holcomb, John B., Wade, Charles E, del Junco, Deborah J., Fox, Erin E., Matijevic, Nena, Podbielski, Jeanette, Beeler, Angela M., Tilley, Barbara C., Baraniuk, Sarah, Zhu, Hongjian, Nixon, Joshua, Seay, Roann, Appana, Savitri N., Yang, Hui, Gonzalez, Michael O., Baer, Lisa, Willa Wang, Yao-Wei, Hula, Brittany S., Espino, Elena, Nguyen, An, Pawelczyk, Nicholas, Arora-Nutall, Kisha D., Sharma, Rishika, Cardenas, Jessica C., Rahbar, Elaheh, Burnett, Tyrone, Jr., Clark, David, van Belle, Gerald, May, Susanne, Leroux, Brian, Hoyt, David, Powell, Judy, Sheehan, Kellie, Hubbard, Alan, Arkin, Adam P., Hess, John R., Callum, Jeanne, Cotton, Bryan A., Vincent, Laura, Welch, Timothy, Poole, Tiffany, Pivalizza, Evan G., Gumbert, Sam D., Bai, Yu, McCarthy, James J., Noland, Amy, Hobbs, Rhonda, Bulger, Eileen M., Klotz, Patricia, Cattin, Lindsay, Warner, Keir J., Wilson, Angela, Boman, David, White, Nathan, Grabinsky, Andreas, Daniel-Johnson, Jennifer A., Cohen, Mitchell Jay, Callcut, Rachael A., Nelson, Mary, Redick, Brittney, Conroy, Amanda, Steurer, Marc P., Maxim, Preston C, Fiebig, Eberhard, Moore, Joanne, Mallari, Eireen, Muskat, Peter, Johannigman, Jay A., Robinson, Bryce RH., Branson, Richard D., Gomaa, Dina, Barczak, Christopher, Bennett, Suzanne, Carey, Patricia M., Miller, Christopher N., Hancock, Helen, Rodriguez, Carolina, Inaba, Kenji, Zhu, Jay G., Wong, Monica D., Menchine, Michael, Katzberg, Kelly, Henderson, Sean O., McKeever, Rodney, Shulman, Ira A., Nelson, Janice M., Tuma, Christopher W., Matsushita, Cheryl Y, Scalea, Thomas M., Stein, Deborah M., Shaffer, Cynthia K., Wade, Christine, Herrera, Anthony V., Kallam, Seeta, Wade, Sarah E., Galvagno, Samuel M., Jr., Fontaine, Magali J., Hunt, Janice M., Cooke, Rhonda K., Fabian, Timothy C., Weinberg, Jordan A., Croce, Martin A., Wilson, Suzanne, Panzer-Baggett, Stephanie, Waddle-Smith, Lynda, Flax, Sherri, Brasel, Karen J., Walsh, Pamela, Milia, David, Nelson, Allia, Kaslow, Olga, Aufderheide, Tom P., Gottschall, Jerome L., Carpenter, Erica, O'Keeffe, Terence, Rokowski, Laurel L., Denninghoff, Kurt R., Redford, Daniel T., Novak, Deborah J., Knoll, Susan, Kerby, Jeffrey D., Pittet, Jean-Francois, Bosarge, Patrick L., Pierce, Albert T., Williams, Carolyn R., Stephens, Shannon W., Wang, Henry E., Marques, Marisa B., Schreiber, Martin A., Watters, Jennifer M., Underwood, Samantha J., Groat, Tahnee, Newgard, Craig, Merkel, Matthias, Scanlan, Richard M., Miller, Beth, Rizoli, Sandro, Tien, Homer, Nascimento, Barto, Trpcic, Sandy, Sobrian-Couroux, Skeeta, Reis, Marciano, Pérez, Adic, Belo, Susan E., Merkley, Lisa, Colavecchia, Connie, Wei, Shuyan, Gonzalez Rodriguez, Erika, Chang, Ronald, Kao, Lillian S., and Wade, Charles E.

Published
2018
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25. Onset of Coagulation Function Recovery Is Delayed in Severely Injured Trauma Patients with Venous Thromboembolism

Author

Holcomb, John B., Wade, Charles E., del Junco, Deborah J., Fox, Erin E., Matijevic, Nena, Podbielski, Jeanette, Beeler, Angela M., Tilley, Barbara C., Baraniuk, Sarah, Nixon, Joshua, Seay, Roann, Appana, Savitri N., Yang, Hui, Gonzalez, Michael O., Baer, Lisa, Willa Wang, Yao-Wei, Hula, Brittany S., Espino, Elena, Nguyen, An, Pawelczyk, Nicholas, Arora-Nutall, Kisha D., Sharma, Rishika, Cardenas, Jessica C., Rahbar, Elaheh, Burnett, Tyrone, Jr., Clark, David, van Belle, Gerald, May, Susanne, Leroux, Brian, Hoyt, David, Powell, Judy, Sheehan, Kellie, Hubbard, Alan, Arkin, Adam P., Hess, John R., Callum, Jeanne, Cotton, Bryan A., Vincent, Laura, Welch, Timothy, Poole, Tiffany, Pivalizza, Evan G., Gumbert, Sam D., Bai, Yu, McCarthy, James J., Noland, Amy, Hobbs, Rhonda, Bulger, Eileen M., Klotz, Patricia, Cattin, Lindsay, Warner, Keir J., Wilson, Angela, Boman, David, White, Nathan, Grabinsky, Andreas, Daniel-Johnson, Jennifer A., Cohen, Mitchell Jay, Callcut, Rachael A., Nelson, Mary, Redick, Brittney, Conroy, Amanda, Steurer, Marc P., Maxim, Preston C., Fiebig, Eberhard, Moore, Joanne, Mallari, Eireen, Muskat, Peter, Johannigman, Jay A., Robinson, Bryce RH., Branson, Richard D., Gomaa, Dina, Barczak, Christopher, Bennett, Suzanne, Carey, Patricia M., Miller, Christopher N., Hancock, Helen, Rodriguez, Carolina, Inaba, Kenji, Zhu, Jay G., Wong, Monica D., Menchine, Michael, Katzberg, Kelly, Henderson, Sean O., McKeever, Rodney, Shulman, Ira A., Nelson, Janice M., Tuma, Christopher W., Matsushita, Cheryl Y., Scalea, Thomas M., Stein, Deborah M., Shaffer, Cynthia K., Wade, Christine, Herrera, Anthony V., Kallam, Seeta, Wade, Sarah E., Galvagno, Samuel M., Jr., Fontaine, Magali J., Hunt, Janice M., Cooke, Rhonda K., Fabian, Timothy C., Weinberg, Jordan A., Croce, Martin A., Wilson, Suzanne, Panzer-Baggett, Stephanie, Waddle-Smith, Lynda, Flax, Sherri, Brasel, Karen J., Walsh, Pamela, Milia, David, Nelson, Allia, Kaslow, Olga, Aufderheide, Tom P., Gottschall, Jerome L., Carpenter, Erica, O'Keeffe, Terence, Rokowski, Laurel L., Denninghoff, Kurt R., Redford, Daniel T., Novak, Deborah J., Knoll, Susan, Kerby, Jeffrey D., Pittet, Jean-Francois, Bosarge, Patrick L., Pierce, Albert T., Williams, Carolyn R., Stephens, Shannon W., Wang, Henry E., Marques, Marisa B., Schreiber, Martin A., Watters, Jennifer M., Underwood, Samantha J., Groat, Tahnee, Newgard, Craig, Merkel, Matthias, Scanlan, Richard M., Miller, Beth, Rizoli, Sandro, Tien, Homer, Nascimento, Barto, Trpcic, Sandy, Sobrian-Couroux, Skeeta, Reis, Marciano, Pérez, Adic, Belo, Susan E., Merkley, Lisa, Colavecchia, Connie, McCully, Belinda H., Connelly, Christopher R., and Fair, Kelly A.

Published
2017
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26. Bacchus Listed for a Liver Transplant: Comment

Author

Bezinover, Dmitri, Diaz, Geraldine, Duggan, Elizabeth, Galusca, Dragos, Kindscher, James D., Moguilevitch, Marina, Nicolau-Raducu, Ramona, Pivalizza, Evan G., Planinsic, Raymond, Ramsay, Michael A. E., Rosenfeld, David M., Skubas, Nikolaos, and Wagener, Gebhard

Published
2020
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27. Trauma Anesthesiology

Author

Dutton, Richard P., primary, Grissom, Thomas E., additional, Herbstreit, Frank, additional, and Pivalizza, Evan G., additional

Published
2023
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28. Association of Opioid Administration During General Anesthesia and Survival for Severely Injured Trauma Patients: A Preplanned Secondary Analysis of the PROPPR Study

Author

Levy, Dominique T., primary, Livingston, Colleen E., additional, Saroukhani, Sepideh, additional, Fox, Erin E., additional, Wade, Charles E., additional, Holcomb, John B., additional, Gumbert, Sam D., additional, Galvagno, Samuel M., additional, Kaslow, Olga Y., additional, Pittet, Jean-Francois, additional, and Pivalizza, Evan G., additional

Published
2023
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39. In Response

Author

Pivalizza, Evan G., Sridhar, Srikanth, Rossmann, Susan, and Cotton, Bryan A.

Published
2018
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41. Characteristics of Academic Anesthesiologist’s Elected to an Institutional Academy of Master Educators

Author

Pivalizza, Evan G, primary, Guzman-Reyes, Sara, additional, Stephens, Christopher, additional, Ekeoduru, Rhashedah A, additional, Nwokolo, Omonele O, additional, Normand, Katherine C, additional, Sridhar, Srikanth, additional, Markham, Travis H, additional, DeHaan, Johanna B, additional, Williams, George, additional, and Rosenfeld, Gary C, additional

Published
2022
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50. Thromboelastography-Guided Therapy Enhances Patient Blood Management in Cirrhotic Patients: A Meta-analysis Based on Randomized Controlled Trials.

Author

Hartmann, Jan, Dias, Joao D., Pivalizza, Evan G., and Garcia-Tsao, Guadalupe

Subjects
RANDOMIZED controlled trials, BLOOD products, PLASMA products, INTENSIVE care units, PLATELET function tests, BLOOD transfusion, BLOOD platelet transfusion
Abstract

Patients with cirrhosis often have abnormal hemostasis, with increased risk of hemorrhage and thrombosis. Thromboelastography provides a rapid assessment of the coagulation status and can guide product transfusions in adult patients with cirrhosis. This study aimed to determine whether the use of thromboelastography in adult patients with cirrhosis decreases blood product use and impacts adverse events or mortality compared with standard practice. A registered (PROSPERO CRD42020192458) systematic review and meta-analysis was conducted for randomized controlled trials (RCTs) comparing thromboelastography-guided hemostatic management versus standard practice (control). Co-primary outcomes were the number of transfused platelet units and fresh frozen plasma (FFP) units. Secondary outcomes were mortality, adverse events, utilization of individual blood products, blood loss or excessive bleeding events, hospital/intensive care unit stay, and liver transplant/intervention outcomes. The search identified 260 articles, with five RCTs included in the meta-analysis. Platelet use was five times lower with thromboelastography versus the control, with a relative risk of 0.17 (95% confidence interval [CI]: [0.03–0.90]; p = 0.04), but FFP use did not differ significantly. Thromboelastography was associated with less blood product (p < 0.001), FFP + platelets (p < 0.001), and cryoprecipitate (p < 0.001) use. No differences were reported in bleeding rates or longer term mortality between groups, with the thromboelastography group having lower mortality at 7 days versus the control (relative risk [95% CI] = 0.52 [0.30–0.91]; p = 0.02). Thromboelastography-guided therapy in patients with cirrhosis enhances patient blood management by reducing use of blood products without increasing complications. [ABSTRACT FROM AUTHOR]

Published
2023
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