Thrombin Generation Kinetics are Predictive of Rapid Transfusion in Trauma Patients Meeting Critical Administration Threshold

Taleen A. Macarthur, Grant M. Spears, Rosemary A. Kozar, Jing Fei Dong, Matthew Auton, Donald H. Jenkins, Kent R. Bailey, Aneel A. Ashrani, Mike J. Ferrara, Joseph M. Immermann, Timothy M. Halling, Myung S. Park

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Introduction:We hypothesize that a patient (pt) with accelerated thrombin generation, time to peak height (ttPeak), will have a greater odds of meeting critical administration threshold (CAT) criteria (> 3 packed red blood cell [pRBC] transfusions [Tx] per 60 min interval), within the first 24 h after injury, independent of international normalized ratio (INR).Methods:In a prospective cohort study, trauma patients were enrolled over a 4.5-year period and serial blood samples collected at various time points. We retrospectively stratified pts into three categories: CAT+, CAT- but receiving some pRBC Tx, receiving no Tx within the first 24 h. Blood collected prior to Tx was analyzed for thrombin generation parameters and prothrombin time (PT)/INR.Results:A total of 484 trauma pts were analyzed: injury severity score = 13 [7,22], age = 48 [28, 64] years, and 73% male. Fifty pts met criteria for CAT+, 64 pts CAT-, and 370 received no Tx. Risk factors for meeting CAT+: decreased arrival systolic blood pressure (OR 2.82 [2.17, 3.67]), increased INR (OR 2.09, [1.66, 2.62]) and decreased time to peak OR 2.27 [1.74, 2.95]). These variables remained independently associated with increased risk of requiring Tx in a multivariable logistic model, after adjusting for sex and trauma type.Conclusions:Pts in hemorrhagic shock, who meet CAT+ criteria, are characterized by accelerated thrombin generation. In our multivariable analysis, both ttPeak and PT/INR have a complementary role in predicting those injured patients who will require a high rate of Tx.

Original languageEnglish (US)
Pages (from-to)321-325
Number of pages5
Issue number3
StatePublished - Mar 1 2021
Externally publishedYes


  • Coagulation
  • coagulopathy
  • hemorrhage
  • shock
  • transfusion
  • trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Emergency Medicine


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