Trauma-induced Coagulopathy

Trauma is still amongst the most prevalent causes of death worldwide, leading to several million casualties per year. Most of these deaths result from severe bleeding and occur in the first few hours after injury, even after arrival in the emergency room. Seriously injured patients often suffer from a disturbance of blood coagulation, a so-called coagulopathy. Due to their injuries, these patients are under a high risk to die, which is why a specific administration of medication and clotting factors at the right time is crucial.

The group around Herbert Schöchl is putting most of its research efforts on how these disturbances in blood clotting occur and how they can be prevented and treated by giving the right medication and blood components at the right time. Coagulation factors in the plasma of patients are essential for stopping the bleeding, but not all factors are equally affected by major blood loss. Fibrinogen for example is the primary substrate in coagulation and reaches critical levels faster than other factors. Current research topics are:

  • Platelet function following major trauma
  • Molecular and cellular mechanisms of hyperfibrinolysis
  • Optimization of therapies in transfusion medicine
  • Establishment of novel methods for “theragnostics”

In order to make quick and goal-oriented decisions regarding therapy, it is important to conduct testing next to the patient that needs to be treated. The term “theragnostics” that combines “therapy” and “diagnostics” was coined to embody this approach. It incorporates the quick diagnosis of clotting disturbances in seriously injured patients in order to improve therapeutic intervention in the clinical setting.

a. Fibrin molecules combine to form long fibrin threads that entangle blood cells.

Selected Publications

Zipperle J, Oberladstätter D, Weichselbaum N, Schlimp CJ, Hofmann N, Iapichino G, Voelckel W, Ziegler B, Grottke O, Osuchowski MF, Schöchl H (2022) Thromboelastometry fails to detect autoheparinization after major trauma and hemorrhagic shock. J Trauma Acute Care Surg2022 Mar 1;92(3):535-541.

Oberladstätter D, Schlimp C, Zipperle J, Osuchowski MF, Voelckel W, Grottke O, Schöchl H (2021) Impact of Idarucizumab and Andexanet Alfa on DOAC Plasma Concentration and ClotPro ® Clotting Time: An Ex Vivo Spiking Study in A Cohort of Trauma Patients. J Clin Med. 2021 Aug 6;10(16):3476.
(free PDF)

Weichselbaum N, Oberladstätter D, Schlimp C, Zipperle J, Voelckel W, Grottke O, Zimmermann G, Osuchowski MF, Schöckl H (2021) High Interleukin-6 Plasma Concentration upon Admission Is Predictive of Massive Transfusion in Severely Injured Patients. J Clin Med2021 May 24;10(11):2268.
(free PDF)

Oberladstätter D, Voelckel W, Schlimp C, Zipperle J, Ziegler B, Grottke O, Schöchl H (2020) A prospective observational study of the rapid detection of clinically-relevant plasma direct oral anticoagulant levels following acute traumatic injury. Anaesthesia. 2020 Sep 18

Gratz J, Martin Ponschab M, Iapichino GE, Schlimp CJ, Cadamuro J, Grottke O, Zipperle J, Oberladstätter D, Gabriel C, Ziegler B, Schöchl H (2020) Comparison of fresh frozen plasma vs. coagulation factor concentrates for reconstitution of blood: An in vitro study. Eur J Anaesthesiol. 2020 Oct;37(10):879-888.

Ziegler B, Voelckel W, Zipperle J, Grottke O, Schöchl H (2019) Comparison between the new fully automated viscoelastic coagulation analysers TEG 6s and ROTEM Sigma in trauma patients: A prospective observational study. Eur J Anaesthesiol. 2019 Nov;36(11):834-842.

Hofmann N, Zipperle J, Brettner F, Jafarmadar M, Ashmwe M, Keibl C, Ponschab M, Kipman U, Bahrami A, Redl H, Bahrami S, Fuhrmann V, Schöchl H (2019). Effect of Coagulation Factor Concentrates on Markers of Endothelial Cell Damage in Experimental Hemorrhagic Shock. Shock 2019 Nov 29.

Zipperle J, Altenburger K, Ponschab M, Schlimp CJ, Spittler A, Bahrami S, Redl H, Schöchl H (2017). Potential role of platelet-leukocyte aggregation in trauma-induced coagulopathy: Ex vivo findings. J Trauma Acute Care Surg, 82(5):921-926.

Schöchl H, Grottke O, Sutor K, Dony K, Schreiber M, Ranucci M, Collins PW (2017). Theoretical Modeling of Coagulation Management With Therapeutic Plasma or Prothrombin Complex Concentrate. Anesth Analg, 125(5):1471-1474

Maegele M, Grottke O, Schöchl H, Sakowitz OA, Spannagl M & Koscielny J (2016). Direct Oral Anticoagulants in Emergency Trauma Admissions. Dtsch Arztebl Int, 113(35-36):575-582.
(free PDF)

Schlimp CJ, Ponschab M, Voelckel W, Treichl B, Maegele M & Schöchl H (2016). Fibrinogen levels in trauma patients during the first seven days after fibrinogen concentrate therapy: a retrospective study. Scand J Trauma Resusc Emerg Med, 24:29.
(free PDF)

Maegele M, Schöchl H & Cohen MJ (2014). An update on the coagulopathy of trauma. Shock, 41 Suppl 1:21-25.

Haas T, Fries D, Tanaka KA, Asmis L, Curry NS, Schöchl H (2014). Usefulness of standard plasma coagulation tests in the management of perioperative coagulopathic bleeding: is there any evidence? Br J Anaesth, 114(2):217-224.

Schöchl H & Schlimp CJ (2014). Trauma bleeding management: the concept of goal-directed primary care. Anesth Analg, 119(5):1064-1073.

Inaba K, Karamanos E, Lustenberger T, Schöchl H, Shulman I, Nelson J, Rhee P, Talving P, Lam L & Demetriades D (2013). Impact of fibrinogen levels on outcomes after acute injury in patients requiring a massive transfusion. J Am Coll Surg, 216(2):290-297.

Schöchl H, Voelckel W, Grassetto A & Schlimp CJ (2013). Practical application of point-of-care coagulation testing to guide treatment decisions in trauma. J Trauma Acute Care Surg, 74(6):1587-1598.

Schöchl H, Maegele M, Solomon C, Görlinger K & Voelckel W (2012). Early and individualized goal-directed therapy for trauma-induced coagulopathy. Scand J Trauma Resusc Emerg Med, 20:15.
(free PDF)

Cotton BA, Harvin JA, Kostousouv V, Minei KM, Radwan ZA, Schöchl H, Wade CE, Holcomb JB & Matijevic N (2012). Hyperfibrinolysis at admission is an uncommon but highly lethal event associated with shock and prehospital fluid administration. J Trauma Acute Care Surg, 73(2):365-370.

Görlinger K, Fries D, Dirkmann D, Weber CF, Hanke AA & Schöchl H (2012). Reduction of fresh frozen plasma requirements by perioperative point-of-care coagulation management with early calculated goal-directed therapy. Transfus Med Hemother, 39(2):104-113.
(free PDF)

Schöchl H, Nienaber U, Maegele M, Hochleitner G, Primavesi F, Steitz B, Arndt C, Hanke A, Voelckel W & Solomon C (2011). Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy. Crit Car, 15(2):R83.
(free PDF)

Schöchl H, Cotton B, Inaba K, Nienaber U, Fischer H, Voelckel W & Solomon C (2011). FIBTEM provides early prediction of massive transfusion in trauma. Crit Care, 15(6):R265.
(free PDF)

Solomon C, Traintinger S, Ziegler B, Hanke A, Rahe-Meyer N, Voelckel W & Schöchl H (2011). Platelet function following trauma: A multiple electrode aggregometry study. Thromb Haemost, 106(2):322-330.

Schöchl H, Nienaber U, Hofer G, Voelckel W, Jambor C, Scharbert G, Kozek-Langenecker S & Solomon C (2010). Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM)-guided administration of fibrinogen concentrate and prothrombin complex concentrate. Crit Care, 14(2):R55.
(free PDF)

Solomon C, Pichlmaier U, Schoechl H, Hagl C, Raymondos K, Scheinichen D, Koppert W & Rahe-Meyer N (2010). Recovery of fibrinogen after administration of fibrinogen concentrate to patients with severe bleeding after cardiopulmonary bypass surgery. Br J Anaesth, 104(5):555-562.
(free PDF)

Schöchl H, Frietsch T, Pavelka M & Jámbor C (2009). Hyperfibrinolysis after major trauma: differential diagnosis of lysis patterns and prognostic value of thrombelastometry. J Trauma, 67(1):125-131.