Exposing the Bidirectional Effects of Alcohol on Coagulation in Trauma: Impaired Clot Formation and Decreased Fibrinolysis in Rotational Thromboelastometry

Exposing the Bidirectional Effects of Alcohol on Coagulation in Trauma: Impaired Clot Formation... Abstract Background Alcohol has been associated with altered viscoelastic testing in trauma, indicative of impaired coagulation. Such alterations, however, show no correlation to coagulopathy-related outcomes. Other data suggests that alcohol may inhibit fibrinolysis. We sought to clarify these mechanisms following traumatic injury using thromboelastometry (ROTEM), hypothesizing that alcohol-related clot formation impairment may be counter-balanced by inhibited fibrinolysis. Methods Laboratory, demographic, clinical, and outcome data were prospectively collected from 406 critically-injured trauma patients at a Level 1 Trauma Center. ROTEM and standard coagulation measures were conducted in parallel. Univariate comparisons were performed by alcohol level (EtOH), with subsequent regression analysis. Results Among 274 patients (58%) with detectable EtOH, median EtOH was 229 mg/dL. These patients were primarily bluntly injured and had lower GCS (p<0.05) than EtOH-negative patients, but had similar admission pH and injury severity (p=NS). EtOH-positive patients had prolonged ROTEM clotting time (CT) and rate of clot formation (CFT/α); they also had decreased fibrinolysis (max lysis %; all p<0.05). In linear regression, for every 100mg/dL increase in EtOH, CT increased by 13s and fibrinolysis decreased by 1.5% (both p<0.05). However, EtOH was not an independent predictor of transfusion requirements or mortality. In high-EtOH patients with coagulopathic ROTEM tracings, transfusion rates were significantly lower than expected, relative to EtOH-negative patients with similar ROTEM findings. Conclusions As assayed by ROTEM, alcohol appears to have a bidirectional effect on coagulation in trauma, both impairing initial clot formation and inhibiting fibrinolysis. This balancing of mechanisms may explain lack of correlation between altered ROTEM and coagulopathy-related outcomes. Viscoelastic testing should be utilized with caution in intoxicated trauma patients. Study Type Epidemiological study. Type III. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The Journal of Trauma and Acute Care Surgery Wolters Kluwer Health

Exposing the Bidirectional Effects of Alcohol on Coagulation in Trauma: Impaired Clot Formation and Decreased Fibrinolysis in Rotational Thromboelastometry

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Publisher
Wolters Kluwer Health
Copyright
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
2163-0755
eISSN
2163-0763
D.O.I.
10.1097/TA.0000000000001716
Publisher site
See Article on Publisher Site

Abstract

Abstract Background Alcohol has been associated with altered viscoelastic testing in trauma, indicative of impaired coagulation. Such alterations, however, show no correlation to coagulopathy-related outcomes. Other data suggests that alcohol may inhibit fibrinolysis. We sought to clarify these mechanisms following traumatic injury using thromboelastometry (ROTEM), hypothesizing that alcohol-related clot formation impairment may be counter-balanced by inhibited fibrinolysis. Methods Laboratory, demographic, clinical, and outcome data were prospectively collected from 406 critically-injured trauma patients at a Level 1 Trauma Center. ROTEM and standard coagulation measures were conducted in parallel. Univariate comparisons were performed by alcohol level (EtOH), with subsequent regression analysis. Results Among 274 patients (58%) with detectable EtOH, median EtOH was 229 mg/dL. These patients were primarily bluntly injured and had lower GCS (p<0.05) than EtOH-negative patients, but had similar admission pH and injury severity (p=NS). EtOH-positive patients had prolonged ROTEM clotting time (CT) and rate of clot formation (CFT/α); they also had decreased fibrinolysis (max lysis %; all p<0.05). In linear regression, for every 100mg/dL increase in EtOH, CT increased by 13s and fibrinolysis decreased by 1.5% (both p<0.05). However, EtOH was not an independent predictor of transfusion requirements or mortality. In high-EtOH patients with coagulopathic ROTEM tracings, transfusion rates were significantly lower than expected, relative to EtOH-negative patients with similar ROTEM findings. Conclusions As assayed by ROTEM, alcohol appears to have a bidirectional effect on coagulation in trauma, both impairing initial clot formation and inhibiting fibrinolysis. This balancing of mechanisms may explain lack of correlation between altered ROTEM and coagulopathy-related outcomes. Viscoelastic testing should be utilized with caution in intoxicated trauma patients. Study Type Epidemiological study. Type III.

Journal

The Journal of Trauma and Acute Care SurgeryWolters Kluwer Health

Published: Apr 1, 2017

References

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