THE HYPERFIBRINOLYTIC PHENOTYPE IS THE MOST LETHAL AND RESOURCE INTENSE PRESENTATION OF FIBRINOLYSIS IN MASSIVE TRANSFUSION PATIENTS.

BACKGROUND: Among bleeding patients, we hypothesized that the hyperfibrinolytic (HF) phenotype would be associated with the highest mortality, while shutdown (SD) patients would have the greatest complication burden. METHODS: Severely injured patients predicted to receive a massive transfusion at 12 level-1 trauma centers were randomized to one of two transfusion ratios as described in the PROPPR trial. Fibrinolysis phenotypes were determined based on admission clot lysis at 30 minutes (LY30): SD =3%. Univariate and multivariate analysis was performed. Logistic regression was used to adjust for age, gender, arrival physiology, shock, injury severity, center-effect and treatment arm. RESULTS: Among the 680 patients randomized, 547(80%) had admission TEG values available to determine fibrinolytic phenotypes. Compared to SD and PHYS, HF patients had higher ISS (25 vs. 25. vs. 34), greater base deficit (-8 vs. -6 vs. -12) and were more uniformly hypocoagulable on admission by PT, PTT and TEG values; all p

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