ACUTE TRAUMATIC COAGULOPATHY
Centre for Trauma SciencesQueen Mary University of Londonwww.c4ts.qmul.ac.uk
Royal London Major Trauma CentreBarts Health NHS Trust
KARIM BROHI, FRCS FRCAProfessor of Trauma Sciences, QMUL
0%
20%
40%
60%
0 - 3 4 - 7 8 - 11 12 - 15 16 - 19 20 - 23 24 - 27 28 - 31
Mor
talit
y (%
)
PRBCs in 24 Hours
Acute Traumatic CoagulopathyATC
HAEMOSTATIC Resuscitation
1. Early haemorrhage control (DCS)2. Permissive hypotension3. Limit fluid infusions (dilution)4. Target coagulopathy
Hallmarks of ATC
-100
-80
-60
-40
-20
0
20
40
60
80
100
0 10 20 30 40 50 60
Firm
ness
[m
m]
Time [min]
exTEM PTr Comparison
EXTEM PTR<1.2
EXTEM PTR>1.2
ATC:CA5 < 36mm
CRYOSTAT
CRYOSTAT Mortalitya
Standard: Y 7/22 : 32%Early CRYO: 3/21 : 14%
6% hyperfibrinolysis100% mortality
-100
-80
-60
-40
-20
0
20
40
60
80
100
0 10 20 30 40 50 60
Firm
ness
[m
m]
Time [min]
exTEM PTr Comparison
EXTEM PTR<1.2
EXTEM PTR>1.2
0%
20%
40%
60%
80%
100%
≤15 16 - 50 >50
% o
f Pati
ents
% Maximum Lysis
Occult FibrinolysisNormal %ML + PAP 1500-7000ng/ml
Severe Occult FibrinolysisNormal %ML + PAP >7000ng/ml
Overt Fibrinolysis%ML >15%
0%
20%
40%
60%
Normal Occult Severe Occult Overt
% o
f Pati
ents
Hyperfibrinolysis
Mechanism of ATC
Systemic Activation of Protein C
Activ
ated
Pro
tein
C (n
g/m
l)
VIIa IXa Xa +++
+
XIIa XIa
TM TM TM TM
Thrombin
Fibrin+
platelet
Thrombin-TM
Fibrinogen
VIIa IXa Xa
+
XIIa XIa
aPC
PC
-
Thrombin-TM
-Thrombin
Fibrin+
platelet
TM TM TM TM
Fibrinogen
hyperfibrinolysis
VIIa IXa Xa
+
XIIa XIa
aPC
PC
-
Thrombin-TM
-Thrombin
Fibrin+
platelet
TM TM TM TM
Fibrinogen
VIIa IXa Xa
+
XIIa XIa
aPC
PC
-
Thrombin-TM
-FDPs
Plasmin
tPA
+
Thrombin
Fibrin+
platelet
+
Fibrinogen
VIIa IXa Xa
+
XIIa XIa
aPC
PC
-
Thrombin-TM
-FDPs
Plasmin
tPA
+
Thrombin
Fibrin+
platelet
+
Fibrinogen-
VIIa IXa Xa
+
XIIa XIa
aPC
PC
-
Thrombin-TM
-FDPs
Plasmin
tPAPAI-1
+
--
Thrombin
Fibrin+
platelet
+
Fibrinogen-
ACUTE TRAUMATIC COAGULOPATHY
FibrinolysisFibrinogen loss
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