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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.



Cripps MW, Kutcher ME, McCreery RC, Crane IM, Greenberg MD, Cachola LM, Redick BJ, Nelson MF, Cohen MJ. Cause and timing of death in massively transfused trauma patients. J Trauma Acute Care Surg. 2013 Aug;75(2 Suppl 2): S255-262
DOI: 10.1097/TA.0b013e31829a24b4
Kornblith LZ, Howard BM, Cheung CK, Dayter Y, Pandey S, Busch MP, Pati S, Callcut RA, Vilardi, RF, Redick BJ, Nelson MF, Cohen MJ. The whole is greater than the sum of its parts: Hemostatic profiles of whole blood variants. J Trauma Acute Care Surg. 2014;77:818-827
DOI: 10.1097/TA.0000000000000354
Kutcher ME, Cripps MW, McCreery RC, Crane IM, Greenberg MD, Cachola LM, Redick BJ, Nelson MF, Cohen MJ. Criteria for empiric treatment of hyperfibrinolysis after trauma. J Trauma Acute Care Surg. 2012 Jul;73(1):87-93.
DOI: 10.1097/TA.0b013e3182598c70
Kutcher ME, Kornblith LZ, Vilardi RF, Redick BJ, Nelson MF, Cohen MJ. The natural history and effect of resuscitation ratio on coagulation after trauma: A prospective cohort study. Ann Surg. 2014;260:1103-1111.
DOI: 10.1097/SLA.0000000000000366
Kutcher ME, Redick BJ, McCreery RC, Crane IM, Greenberg MD, Cachola LM, Nelson MF, Cohen MJ. Characterization of platelet dysfunction after trauma. J Trauma Acute Care Surg. 2012 Jul;73(1):13-19.
DOI: 10.1097/TA.0b013e318256deab
Kutcher ME, Xu J, Vilardi RF, Ho C, Esmon CT, Cohen MJ. Extracellular histone release in response to traumatic injury: Implications for a compensatory role of activated protein C. J Trauma Acute Care Surg. 2012 Dec;73(6):1387-1392.
DOI: 10.1097/TA.0b013e318270d595
Kutcher ME, Ferguson AR, Cohen MJ. A principal component analysis of coagulation after trauma. J Trauma Acute Care Surg. 2013; 74(5): 1223-120.
DOI: 10.1097/TA.0b013e31828b7fa1