INTRN research projects

Initiated in 2008, the ongoing study entitled "Activation of Coagulation and Inflammation in Trauma (ACIT)" serves as a platform for the enrolment of adult trauma patients in the Emergency Department setting, and the standardised collection of clinical data and patient blood. These study materials support multiple analyses to describe the body's response to injury and blood transfusion therapy. 

Targeted Action for Curing Trauma Induced Coagulopathy (TACTIC) was a 5.5-year (2013-2019) comprehensive programme of comparative clinical research that recruited patients from a network of specialist trauma centres in Amsterdam, Cologne, Copenhagen, London, Nottingham, Oslo and Oxford to compare the effectiveness of different current practices across Europe by:

• Defining the diversity and health economics (costs and health outcomes) of existing treatment strategies across Europe (publication)
• Determining the pathophysiology of TIC by detailing the patient’s molecular and functional clotting response to injury and existing coagulation therapy (publication)
• Enabling the diagnosis of ‘normocoagulable’ patients and different patterns of TIC (publication)
• Delivering the evidence and tools for the accurate measurement of disease burden and efficacy of treatment, in the context of acute-phase mortality and longer-term patient outcomes (e.g. organ failure)
• Enabling the intelligent development of an evidence-based personalised, targeted treatment algorithm to correct functional coagulation (publication)
• Conducting a European multicentre randomised control trial that delivered guidelines for the monitoring and treatment of coagulopathy (publication)

CRYOSTAT-1 was a feasibility study for a multi-centre, randomised controlled trial (RCT) evaluating the effects of early administration of high-dose cryoprecipitate (i.e. a source of fibrinogen) in adults suffering major traumatic haemorrhage. This 1-year study recruited 43 patients by September 2013, with all study patients completing a subsequent 3-month follow-up visit.

We were able to demonstrate the feasibility of delivering early cryoprecipitate in patients at two major trauma centres (Royal London Hospital and John Radcliffe, Oxford).

This study also constituted the UK’s first co-developed civilian-military RCT which was conducted in parallel at Camp Bastion, Afghanistan.

CRYOSTAT-1 suggested that early cryoprecipitate therapy maintained acceptable blood fibrinogen levels during active bleeding, with a signal for reduced mortality (3 deaths vs. 6 deaths) in the treatment arm of the study. More information about the trial can be found in this article and also on the ISRCTNRegistry.