Change in novel plasmin activated clotting time assay predicts hyperfibrinolysis, massive transfusion, and mortality in trauma in under 3 minutes.

BACKGROUND

Hyperfibrinolysis after trauma increases mortality, yet rapid identification remains a challenge. Prior work demonstrates liver transplantation is an idealized model of fibrinolysis. Early resource mobilization and antifibrinolytic therapy improves outcomes in trauma, but efficacy is lost with delays in care. We set out to develop a novel plasmin-activated clotting time (PACT) assay to rapidly diagnose hyperfibrinolysis.

METHODS

Whole blood from adult liver transplant(n ​= ​40) and trauma patients(n ​= ​32) underwent PACT assay alongside traditional and tPA-challenged thromboelastography(TEG). Primary outcomes of massive transfusion and early mortality were assessed.

RESULTS

PACT accurately identified hyperfibrinolysis within 3 ​min during the anhepatic phase of liver transplant (35 ​% prevalence; p ​< ​0.001). In trauma, a PACT threshold (ΔACT >18.5 ​s) predicted massive transfusion or death (AUC ​= ​0.857, p ​< ​0.001), outperforming conventional TEG metrics (AUC<0.625).

CONCLUSION

The PACT assay predicts hyperfibrinolysis, massive transfusion, and mortality in trauma patients in 3 ​min, offering potential for rapid resource triage and early targeted therapeutic administration.