Timing and Mechanism of Traumatic Coagulopathy

Principal Investigator: Mitchell Cohen, MD
Lead Institution: University of California, San Francisco
Participating Centers: UTHSC-Houston, Center for Translational Injury Research (CeTIR) University of California

Uncontrolled hemorrhage and clotting abnormalities (coagulopathy) are responsible for the majority of trauma related deaths in the first 24 hours. Coagulopathy is common following severe trauma and is associated with poor outcome. Unfortunately, the mechanisms for clotting problems are poorly characterized and, as a result, diagnosis is difficult and treatment options are limited. In addition, there is a link between early coagulopathy and later multiple organ failure (MOF), infection, and mortality. The mechanisms for this clotting abnormality, and later inflammation after trauma, are unknown. This study had three aims: 1) to characterize coagulation in severely injured patients in a prospective, multi-center observational study, 2) to identify the central mediators involved in coagulopathy after trauma, and 3) to produce a predictive model to improve diagnosis and treatment after severe trauma. The study found that traumatic brain injury was an independent predictor of platelet hypofunction and highlighted the importance of further investigation into the link between traumatic brain injury and platelet dysfunction. It provided guidelines for the treatment of hyper-fibrinolysis and the role of extracellular histone levels.