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Prevalence and Associated Factors of Acute Traumatic Coagulopathy; a Cross Sectional Study

Hojjat Derakhshanfar, Ali Vafaei, Ali Tabatabaey, Shamila Noori


Introduction: Acute traumatic coagulopathy (ATC) is defined as having evidence of coagulopathy in patients with severe trauma. The aim of this preliminary study was to assess the prevalence and associated factors of ATC in severely traumatic patients presenting to emergency department (ED). Methods: In this retrospective cross sectional study, all patients with severe traumatic injury and available coagulation profile, presenting to the EDs of two major trauma centers in Tehran, Iran, during one year, were studied. Rate of ATC was determined and the associations with various variables as well as outcome were analyzed using SPSS 21. Results: 246 patients with the mean age of 36.57±17.11 years were included (88.2% male). The mean injury severity score (ISS) was 21.83 ± 7.37 (16 – 54). Patients were resuscitated with 676.83 ± 452.02 (0 – 1500) ml intravenous fluid before arriving at the ED. The maximum and minimum frequencies of ATC were 31.3% based on PTT > 36s and 2.4% based on PT > 18s, respectively. There was a significant association between the occurrence of ATC (PT ratio > 1.2) and ISS > 23 (p = 0.001), abdominal abbreviated injury score (AIS) > 3 (p = 0.003), base deficit > 4 (p = 0.019), pulse rate > 90/minute (p = 0.041), and pH < 7.30 (p = 0.043). Conclusion: The frequency of ATC in the present series varied from 2.4% to 31.3% based on different ATC definitions. Abdominal AIS > 3 and base deficit > 4 were among the significant independent factors related to ATC occurrence based on stepwise logistic regression analysis. 


Blood coagulation disorders; multiple trauma; risk factors; emergency service, hospital; outcome assessment


Davenport R, Manson J, De'Ath H, Platton S, Coates A, Allard S, et al. Functional definition and characterization of acute traumatic coagulopathy. Crit Care Med. 2011;39:2652-8.

Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. The Journal of trauma. 2003;54(6):1127-30.

Floccard B, Rugeri L, Faure A, Saint Denis M, Boyle EM, Peguet O, et al. Early coagulopathy in trauma patients: an on-scene and hospital admission study. Injury. 2012;43:26-32.

Mitra B, Cameron Pa, Mori A, Fitzgerald M. Acute coagulopathy and early deaths post major trauma. Injury. 2012;43:22-5.

Mujuni E, Wangoda R, Ongom P, Galukande M. Acute traumatic coagulopathy among major trauma patients in an urban tertiary hospital in sub Saharan Africa. BMC Emerg Med. 2012;12:16.

Rugeri L, Levrat A, David JS, Delecroix E, Floccard B, Gros A, et al. Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography. Journal of thrombosis and haemostasis : JTH. 2007;5(2):289-95.

Maegele M. Acute traumatic coagulopathy: Incidence, risk stratification and therapeutic options. World journal of Emergency Medicine. 2010;1:12-21.

Mitra B, Cameron PA, Mori A, Maini A, Fitzgerald M, Paul E, et al. Early prediction of acute traumatic coagulopathy. Resuscitation. 2011;82(9):1208-13.

Copes WS, Champion HR, Sacco WJ, Lawnick MM, Keast SL, Bain LW. The Injury Severity Score revisited. The Journal of trauma. 1988;28:69-77.

Frith D, Goslings JC, Gaarder C, Maegele M, Cohen MJ, Allard S, et al. Definition and drivers of acute traumatic coagulopathy: Clinical and experimental investigations. Journal of Thrombosis and Haemostasis. 2010;8:1919-25.

Maegele M, Paffrath T, Bouillon B. Acute traumatic coagulopathy in severe injury: incidence, risk stratification, and treatment options. Deutsches Ärzteblatt international. 2011;108:827-35.

Frith D, Davenport R, Brohi K. Acute traumatic coagulopathy. Current opinion in anaesthesiology. 2012;25:229-34.

Brown J, Cohen M, Minei J. Characterization of Acute Coagulopathy and the Gender Dimorphism Post-Injury: Females and Coagulopathy Just Don't Mix. Journal of trauma and acute care surgery. 2012;73:1395-400.

Mitra B, Cameron Pa, Gruen RL. Aggressive fresh frozen plasma (FFP) with massive blood transfusion in the absence of acute traumatic coagulopathy. Injury. 2012;43:33-7.

Armand R, Hess JR. Treating coagulopathy in trauma patients. Transfus Med Rev. 2003;17:223-31.

Hess JR, Hiippala S. Optimizing the use of blood products in trauma care. Critical care (London, England). 2005;9 Suppl 5:S10-4.

Schöchl H, Maegele M, Solomon C, Görlinger K, Voelckel W. Early and individualized goal-directed therapy for trauma-induced coagulopathy. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2012;20:15.

Yücel N, Lefering R, Maegele M, Vorweg M, Tjardes T, Ruchholtz S, et al. Trauma Associated Severe Hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma. The Journal of trauma. 2006;60:1228-36; discussion 36-7.

Nunez TC, Voskresensky IV, Dossett LA, Shinall R, Dutton WD, Cotton BA. Early prediction of massive transfusion in trauma: simple as ABC (assessment of blood consumption)? The Journal of trauma. 2009;66(2):346-52.

Brown JB, Cohen MJ, Minei JP, Maier RV, West MA, Billiar TR, et al. Characterization of acute coagulopathy and sexual dimorphism after injury: females and coagulopathy just do not mix. The journal of trauma and acute care surgery. 2012;73:1395-400.

Brohi K, Cohen MJ, Ganter MT, Matthay MA, Mackersie RC, Pittet JF. Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway? Annals of surgery. 2007;245(5):812-8.

Brohi K, Cohen MJ, Ganter MT, Schultz MJ, Levi M, Mackersie RC, et al. Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. The Journal of trauma. 2008;64(5):1211-7; discussion 7.

Ganter MT, Pittet J-F. New insights into acute coagulopathy in trauma patients. Best practice & research Clinical anaesthesiology. 2010;24:15-25.

DOI: http://dx.doi.org/10.22037/emergency.v5i1.16353

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