BLEEDING AND COAGULATION

Our current research projects are listed below. 

Activation of Coagulation and Inflammation in Trauma (ACIT)

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. Originally a United Kingdom-based study, other high volume trauma centres have since contributed to a combined recruitment of over 3500 trauma patients to ACIT, from countries including Denmark, Germany, Norway, the Netherlands, Sweden and the United States of America.

Within minutes of injury, up to 1 in 4 severely injured patients develop a clotting dysfunction, termed Acute Traumatic Coagulopathy (ATC) that exacerbates bleeding and increases transfusion requirements, morbidity and mortality. ACIT is designed to identify the clinically significant mechanisms by which the body’s inflammation and coagulation pathways are activated immediately following major trauma. It also allows the monitoring of any change in functional blood coagulation, during the course of treatment with blood components and procoagulant agents. The study is revealing how trauma leads to coagulopathy and a perturbed inflammatory response, which leads to increased transfusion requirements and adverse outcome in terms of organ failure and death.

More information about ACIT

Targeted Action for Curing Trauma Induced Coagulopathy (TACTIC)

Current treatment of bleeding and coagulopathy is based on empiric “blind” administration of blood products, with large variations in practice between trauma centres.

Targeted Action for Curing Trauma Induced Coagulopathy (TACTIC) is a five-year (2013-2018) comprehensive programme of comparative clinical research that is recruiting patients from a network of specialist trauma centres in Amsterdam, Cologne, Copenhagen, London, Oslo and Oxford to compare the effectiveness of different current practices across Europe.

More information about TACTIC can be found here and on the TACTIC website

Click here for information about the latest clinical trial iTACTIC

Our fibrinogen discoveries and CRYOSTAT-2

C4TS research to date has shown that low fibrinogen levels of admission to hospital are predictors of early mortality in trauma patients. Fibrinogen is a protein essential for forming blood clots. More information about our fibrinogen discoveries can be found here

In 2013, C4TS undertook CRYOSTAT-1, a small study that found it was feasible to deliver cryoprecipitate to trauma patients within an hour of admission. Cryoprecipitate is a concentrated form of fibrinogen and this appeared to reduce mortality. 

In 2017, C4TS and NHS Blood & Transplant have been awarded £2.4m from the National Institute for Health Research Health and Bart’s Charity to carry out a large multi-centre Randomised Controlled Trial (RCT) to evaluate early cryoprecipitate in major traumatic haemorrhage (CRYOSTAT-2).

The trial will test the effect of early cryoprecipitate (within 90 minutes of admission) compared to standard blood transfusion therapy, on 1544 severely bleeding trauma patients at all Major Trauma Centres (MTCs) across England and selected international partners in North America and Australia. Patient recruitment will commence in July 2017 and the trial will run for 36 months.  The study will provide the answer as to whether early cryoprecipitate transfused for major traumatic bleeding saves lives.

This will be the first national transfusion study in the UK since trauma networks were established in England and Wales. Improved transfusion practices have the potential to save millions of lives globally

More information about CRYOSTAT-1 & 2

Staff and Publications
 

FINDINGS

  • 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

Findings

There is a correlation between red 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

FINDINGS

Our outcomes research has shown that Tranexamic Acid (TXA) use as part of a MTP reduces multi-organ failure and overall mortality in shock patients.

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