Bleeding and Coagulation

Major haemorrhage after injury is a global health burden and remains the leading cause of preventable death for trauma patients. Traumatic exsanguination has challenged civilian and military health systems for many years with extremely high mortality rates, approaching 50% for patients requiring a massive transfusion.

In 2003, Professor Karim Brohi first introduced the term Acute Traumatic Coagulopathy (ATC), establishing that coagulopathy induced by trauma results in more severe bleeding, multi-organ failure and high mortality within minutes of injury.

Many more injured patients will go on to develop different types of coagulopathy at different times during the course of their treatment, either as a result of their body’s on-going response to trauma or as a consequence of their clinical care.

This clotting failure exacerbates life-threatening bleeding and makes surgical repair very difficult, increasing patient’s blood loss and blood transfusion requirements, leading to increased tissue damage, organ failure and death.

This research theme focuses on:

  • Understanding Trauma Induced Coagulopathy (TIC)
  • Finding new drugs to treat this clotting dysfunction
  • Developing new devices for the rapid diagnosis of TIC and monitoring patient’s response to pro-coagulant treatment

Our key findings to date

  • ATC has a specific ROTEM® signature which can be detected within five minutes and can alert clinicians to a trauma patient at greater risk of major bleeding.
  • Using ROTEM® for trauma diagnostics, we have demonstrated that current massive transfusion protocols (MTPs) do not correct coagulopathy.
  • 1 in 8 trauma patients present to the Emergency Department with severe occult fibrinolysis, suggesting MTPs need a greater focus on fibrinogen concentrates and anti-fibrinolytic agents. We have shown that low fibrinogen levels of admission to hospital are predictors of early mortality in trauma patients. Our Cryostat-2 trial will test if the early administration of cryoprecipitate, which is a concentrated form of fibrinogen will save more lives.
  • Tranexamic Acid (TXA) use as part of a MTP reduces multi-organ failure and overall mortality in shock patients.
  • There is a correlation between red blood cell use and number of severely (ISS>15) injured casualties from terror related Mass Casualty Events, which has potential in guiding required on shelf blood stocks for future events.

Our Bleeding and Coagulopathy Research Programme

 

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