Uncontrolled hemorrhage is the second most common cause of trauma-related mortality. Over the last two decades, the management of hemorrhagic shock has shifted from conventional, crystalloid-based resuscitation to hemostatic resuscitation. Transfusion of plasma during hemostatic resuscitation relies in part on the concept that plasma replaces coagulation factors, which are consumed following severe injury and shock.  However, the effect of blood-product administration on factor levels remains poorly understood. We characterized the temporal trends of coagulation factors over the first five days after injury to determine whether plasma transfusion replaces and increases factor levels in trauma patients.

1. JJ Sumislawski1, GR Stettler1, EE Moore1, LZ Kornblith2, AS Conroy2, AD Colvis1, RA Callcut2, CC Silliman1, A Sauaia1, MJ Cohen1
1 Trauma Research Center; Department of Surgery; University of Colorado; Aurora, Colorado
2 Department of Surgery, Zuckerberg San Francisco General Hospital, University of California San Francisco
Uncontrolled hemorrhage is the second most
common cause of trauma-related
mortality. Over the last two decades, the
management of hemorrhagic shock has
shifted from conventional, crystalloid-based
resuscitation to hemostatic resuscitation.
Transfusion of plasma during hemostatic
resuscitation relies in part on the concept that
plasma replaces coagulation factors, which are
consumed following severe injury and shock.
However, the effect of blood-product
administration on factor levels remains poorly
understood. We characterized the temporal
trends of coagulation factors over the first five
days after injury to determine whether plasma
transfusion replaces and increases factor
levels in trauma patients.
Background
Plasma transfusion corrects coagulation
factor deficiencies in trauma patients.
Hypothesis
ResultsMethods
Serial blood samples were collected
prospectively from critically injured
patients at set time points for 120 hours
after arrival at two urban Level I Trauma
Centers.
Patients were considered coagulopathic if
they had an international normalized ratio
≥1.4 and/or partial thromboplastin time
≥35 seconds upon arrival.
The activity levels of factors II, V, VII, VIII,
IX, and X were assessed in each sample
using a Stago Max analyzer.
Conclusions
• Coagulation factor levels remain relatively stable over time
• Plasma resuscitation does not result in replaced or increased factor levels
• The mechanisms underlying the benefits of plasma based resuscitation may not involve clotting factor
repletion and remain poorly understood
120967248241260
Time after Arrival (h)
All Coagulopathic
n=1260​ n=256​
Age (y)​ 35 (25, 51)​ 35 (24, 52)​
Male​ 82%​ 77%​
Blunt mechanism​ 55%​ 61%​
ISS​ 14 (4, 27)​ 26 (10, 38)​
Base excess​ -3.3 (-7.5, 0.3)​ -6.1 (-13.7, -2.6)​
RBC (u), 24 h​ 3.2 (±7.8)​ 8.1 (±12.6)​
Plasma (u), 24 h​ 2.1 (±5.7)​ 5.7 (±9.6)​
Platelets (u), 24 h​ 0.3 (±1.2)​ 0.7 (±2.2)​
Hospital days​ 5 (2, 14)​ 3 (1, 12)​
Mortality​ 17%​ 48%​
Figure 1: Patient activity levels show a non-statistically and non-clinically significant
gradual increases over time
Coagulation Factor Replacement Does Not Explain the Benefits of Plasma-Based Resuscitation after Injury
Study Population
Factor Activities over Time
Relative Change over Time
Figure 3: Plasma transfusion did not increase factor levels at the 6 hour timepoint Figure 4: Plasma transfusion did not increase factor levels at the 24 hour timepoint
Figure 2: Coagulopathic patient activity levels gradually increase without significant
differences between consecutive timepoints
All Patients Coagulopathic Patients
6 Hour 24 Hour