Journal
ANESTHESIA AND ANALGESIA
Volume 113, Issue 5, Pages 1003-1012Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1213/ANE.0b013e31822e183f
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Funding
- Swiss National Science Foundation, Berne, Switzerland [33CM30_124117, 406440-131268]
- Swiss Society of Anesthesiology and Reanimation (SGAR), Berne, Switzerland
- Swiss Foundation for Anesthesia Research, Zurich, Switzerland
- Bundesprogramm Chancengleichheit, Berne, Switzerland
- CSL Behring, Berne, Switzerland
- Vifor SA, Villars-sur-Glane, Switzerland
- Novo Nordisk A/S, Bagsvard, Denmark
- Abbott AG, Baar, Switzerland
- AstraZeneca AG, Zug, Switzerland
- Melsungen AG, Melsungen, Germany
- Boehringer Ingelheim (Schweiz) GmbH, Basel, Switzerland
- Bristol-Myers-Squibb
- Rueil-Malmaison Cedex, France
- CSL Behring GmbH
- Hattersheim am Main, Germany and Bern, Switzerland
- Curacyte AG, Munich, Germany
- Ethicon Biosurgery
- Sommerville, NJ
- Fresenius SE
- Bad Homburg v.d.H., Germany
- Galenica AG, Bern, Switzerland
- GlaxoSmithKline GmbH & Co. KG, Hamburg, Germany
- Janssen-Cilag AG, Baar, Switzerland
- Organon AG, Pfaffikon/SZ, Switzerland
- Oxygen Biotherapeutics, Costa Mesa, CA
- Pentapharm GmbH (now tem Innovations GmbH), Munich, Germany
- Roche Pharma (Schweiz) AG, Reinach, Switzerland
- Schering-Plough International, Inc., Kenilworth, NJ
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BACKGROUND: We investigated whether hyperfibrinolysis and its severity was associated with outcome of traumatized and nontraumatized patients. METHODS: From April 2008 to April 2010, all emergency patients with hyperfibrinolysis were enrolled in this study. Hyperfibrinolysis patients were divided into traumatized (trauma hyperfibrinolysis group) and nontraumatized (nontrauma hyperfibrinolysis group). The trauma hyperfibrinolysis group was matched with 24 polytrauma patients without hyperfibrinolysis (matched trauma group). Data from rotational thromboelastometry measurements, blood gas analysis (metabolic state), laboratory analysis, injury severity score, and 30-day mortality were collected. RESULTS: Thirty-five patients with hyperfibrinolysis were identified (13 traumatized, 22 nontraumatized). Overall mortality for hyperfibrinolysis was 54%. Mortality in the trauma hyperfibrinolysis group (77% +/- 12%) was significantly higher than in the nontrauma hyperfibrinolysis group (41% +/- 10%; P = 0.001, 95% CI 5%-67%) and the matched trauma group (33% +/- 10%; P = 0.009, 95% CI 13%-74%). Hyperfibrinolysis is significantly (P = 0.017) associated with mortality in trauma patients. In the blood gas analysis representing the metabolic state, only pH (P = 0.02) and potassium (P = 0.01) were significantly lower in the trauma hyperfibrinolysis group compared to the nontrauma hyperfibrinolysis group. CONCLUSIONS: Mortality from hyperfibrinolysis is significantly higher in trauma compared with nontrauma patients, and hyperfibrinolysis is an independent factor predicting mortality in trauma patients. Rotational thromboelastometry provides real-time recognition of hyperfibrinolysis allowing early treatment. (Anesth Analg 2011;113:1003-12)
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