Tackling the mystery of why some patients’ blood doesn’t clot
When someone is severely injured, the body’s normal response is for the blood to clot and stop the bleeding – it’s a basic survival mechanism. But for reasons that are still not fully understood, some patients with major trauma don’t clot properly.
According to Royal North Shore Hospital (RNSH) trauma specialist Professor Brian Burns, this happens far more often than people realise, affecting up to 25 per cent of patients with severe injuries. “It makes no biological sense,” he says. “From an evolutionary point of view, if you were mauled by a sabre-toothed tiger, your body’s job was simple: run away and clot fast in the area injured so you didn’t bleed to death. But in some severely injured patients, the opposite happens. The clot doesn’t form properly and it also breaks down quickly.” As Brian explains, the key drivers in causing the problem are severe tissue injury and shock, which can cause fibrinogen to break down rapidly and for its levels to fall. Fibrinogen is a key part of clotting – it acts like the cement in a blood clot, holding the platelet ‘bricks’ together so the body can plug the hole.
In some patients, the fibrinogen breaks down within minutes of severe injury. The condition, known as acute traumatic coagulopathy (ATC), increases a major trauma patient’s risk of death four-fold. And because bleeding is the most preventable cause of death in trauma, understanding and addressing ATC is critical. Landmark study underway Finding the best way to identify and rapidly treat this problem is at the heart of a landmark study involving 900 severely injured patients presenting at hospitals across Australia and New Zealand. RNSH is the largest recruiting hospital for the study in NSW and Brian is part of a large investigation team. The trial, called the Fibrinogen Early in Severe Trauma (FEISTY II) study, seeks to compare two different blood products that contain fibrinogen: a fast-mixing powder called fibrinogen concentrate versus cryoprecipitate, which is frozen and takes around 15 minutes to thaw. Aside from the scale of the trial, Brian says the research is also significant as trauma research has historically lagged behind other fields such as cardiology and oncology, partly because trauma patients are so diverse. “They can be quite a hard group to study scientifically,” he says.
6
Tomorrow’s medicine today
Made with FlippingBook - professional solution for displaying marketing and sales documents online