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Curry, Nicola S.; Davenport, Ross; Wong, Henna; Gaarder, Christine; Johansson, Pär; Juffermans, Nicole P.; Maegele, Marc; Stensballe, Jakob; Brohi, Karim; Laffan, Mike; Stanworth, Simon J.
Journal of thrombosis and haemostasis, February 2023, 2023-02-00, 20230201, Volume: 21, Issue: 2Journal Article
Most studies describing traumatic coagulopathy have used data from patient cohorts with an average age of between 35 and 45 years. The last 10 years has seen a steep increase in the number of patients admitted with significant injury and bleeding who are older than the age of 65 years. Many coagulation protein levels alter significantly with normal aging, and it is possible that traumatic coagulopathy has a different signature with age. The aim of this study was to report the coagulation profiles, including standard and extended laboratory, as well as viscoelastic hemostatic assays, stratified according to age to explore age-related differences in hemostatic capability. In total, 1576 patients were analyzed from 6 European level 1 trauma centers. As age increased, there was evidence of higher fibrinogen, greater thrombin generation, greater clotting factor consumption, and greater activation of fibrinolysis. Despite this, shock and severe injury led to the same pattern of changes within age groups: lower procoagulant factors (including fibrinogen), increased fibrinolysis, and higher levels of activated protein C. Thromboelastography and rotational thromboelastometry tests detected traumatic coagulopathy with prolongation of R/clotting time and reductions in clot amplitudes in each age cohort. Advancing age strongly correlated with higher fibrinogen levels and greater fibrinolysis. Age-related coagulation changes are evident in injured patients. Broadly, similar patterns of coagulation abnormalities are seen across age groups following severe injury/shock, but thresholds for single clotting factors differ. Age-related differences may need to be considered when clinical treatments (eg, transfusion therapy) are indicated. •Most studies that have informed treatment for trauma hemorrhage and its accompanying coagulopathy have relied on data from cohorts of young patients (average age, 35-45 years).•This large, multicenter, prospective study compares the coagulation profiles of injured patients across age groups from 16 years upward to determine whether age-related changes can be seen.•The same patterns of coagulation changes were seen in younger and older patient cohorts in response to injury (eg, low fibrinogen levels, high activated protein C levels, and hyperfibrinolysis).•For similar degrees of injury, higher fibrinogen levels, greater thrombin generation, and greater fibrinolysis were evident as age increased.
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