Early Rotem Evaluation Abnormalities May Be Associated with Hemorragic but Not Thromboembolic Complications in Patients with Major Trauma Referred to Hospital Within the First Hour

Background: Trauma-induced coagulopathy is associated with a high rate of hemorrhagic complications and with increased mortality after major trauma. Viscoelastic techniques have been demonstrated to be useful for early diagnosis and appropriate management in these patients. Methods: This prospective observational study included patients who underwent major trauma (ISS (injury severity score) > 15) and were referred to hospital within the first hour. All underwent early ROTEM evaluation. Results: The study included 100 patients (80 males, 20 females, mean age 52.41 years). Twenty-three had bleeding, requiring transfusion (mean age of 57.3 years and ISS 21.7). According to accepted criteria of hypocoagulability, 10/23 (43.5%) had at least one abnormality in one of the ROTEM parameters. EXTEM CT was significantly longer in transfused patients. Four had symptomatic VTE (venous thromboembolism), and Doppler examination showed DVT (deep venous thrombosis) in 14 (14%) of the population. Sepsis, pneumonia, and acute renal failure were statistically more frequent in patients with thrombosis, while no relation was found with ROTEM. Finally, 3 out of 5 patients who died showed a severe hypocoagulable condition at initial ROTEM evaluation. Conclusions: In patients with major trauma referred to hospital within the first hour, early qualitative ROTEM examination at admission may be useful in identifying patients at bleeding risk. Sepsis, pneumonia, and acute renal failure, but not ROTEM parameters, were associated with the risk of thromboembolic events.