OC 11.5 - Correction of Coagulopathy in Trauma Haemorrhage - Still Room for Improvement. A Secondary Analysis of the ITACTIC trial

Sunday, July 10, 2022

11:45 AM – 12:00 PM

Location: ExCel Center, ICC Auditorium

Presentation Format: In-Person

Presenting Author(s)

Charlotte Lindsay, MSc

Clinical Research Fellow
Queen Mary University of London
London, England, United Kingdom

Co-Author(s)

KB

Kjersti Baksaas-Aasen

Consultant Anaesthetist
Oslo University Hospital & University of Oslo
Oslo, Oslo, Norway
Nicole Juffermans, MD, PhD

Professor of translational intensive care medicine
Amsterdam University Medical Centre
Amsterdam, Noord-Holland, Netherlands
Nicola Curry, MD

Consultant Haematologist
Oxford University Hospitals NHS Foundation Trust
Oxford, England, United Kingdom
MM

Marc Maegele

Professor
Cologne-Merheim Medical Centre, University of Witten/Herdecke
Cologne, Nordrhein-Westfalen, Germany
JS

Jakob Stensballe

Consultant Anaesthetist
Copenhagen University Hospital
Copenhagen, Hovedstaden, Denmark
SS

Simon J. Stanworth, DPhil FRCP FRCPath

Professor
Oxford University Hospitals/NHS Blood and Transplant
Oxford, England, United Kingdom
Ross A. Davenport, PhD FRCS

Senior Lecturer in Trauma Sciences and Consultant Trauma & Vascular Surgeon
Centre for Trauma Science, Queen Mary Univeristy of London, UK - Barts Health NHS Trust, London, UK
London, England, United Kingdom
PN

Pål Aksel Næss

Professor
Oslo University Hospital & University of Oslo
Oslo, Oslo, Norway
CG

Christine Gaarder

Professor
Oslo University Hospital & University of Oslo
Amsterdam, Oslo, Norway
Karim Brohi, FRCS FRCA

Chair of Trauma Sciences
Queen Mary University of London
London, England, United Kingdom

Background: Viscoelastic haemostatic assays (VHAs) have advantages over conventional coagulation tests in terms of speed, sensitivity and ability to direct interventions. However, in the ITACTIC trial, comparing major haemorrhage protocols augmented with VHA or CCT guided intervention, there was no overall outcome benefit observed in the VHA arm, despite patients receiving a greater number of targeted interventions more quickly.

Aims: We aimed to explore the effect of targeted transfusion therapies on coagulation parameters in all patients, and a coagulopathic subgroup in the ITACTIC cohort.

Methods: We analysed a subgroup of ITACTIC patients, co-enrolled into the ACIT observational study of coagulation and inflammation after trauma (REC 16/LO/0004 & 07/Q0603/2). We compared coagulation values at baseline and after 4, 8 and 12 units in the whole cohort and in a subgroup who received at least 8 units of RBCs and were coagulopathic at any time point (defined as EXTEM CA5 < 40mm).

Results: 139 patients met the inclusion criteria. Overall, coagulopathy worsened substantially during bleeding (EXTEM CA5 36mm at baseline vs 28mm at 12units). VHA and CCT tests were closer to normal in survivors and in those who received targeted treatment but were not different between the two ITACTIC trial arms. In the subgroup of coagulopathic patients who received at least 8 RBCs, correction of coagulopathy was achieved in more survivors than non survivors (29% vs 13%). Coagulopathy was not corrected in any patient who received only empiric treatment, while targeted therapy corrected coagulation tests in only 25% of subjects. Correction of coagulopathy was greater in the VHA arm (33% vs 16%), and targeted transfusion therapy was administered earlier in this group (100 mins vs 121 mins).

Conclusion(s): Current treatments for trauma induced coagulopathy are not sufficient to correct coagulopathy in the majority of bleeding trauma patients.