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.
The Journal of Trauma and Acute Care Surgery – Wolters Kluwer Health
Published: Apr 1, 2017
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