1: 1 transfusion strategies are right for the wrong reasons.

Introduction: Early assessment of clot function identifies coagulopathies following injury. Abnormalities include a hypercoagulable state from excess thrombin generation, as well as an acquired coagulopathy. Efforts to address coagulopathy have resulted in earlier, aggressive use of plasma emphasizing 1:1 resuscitation. The purpose of this study was to describe coagulopathies in varying hemorrhagic profiles from a cohort of injured patients. Methods: All injured patients who received at least one unit of packed red blood cells (PRBC) in the first 24 hours of admission from September 2013 to May 2015 were eligible for inclusion. Group-based trajectory modeling, using volume of transfusion over time, was used to identify specific hemorrhagic phenotypes. The TEG profile of each subgroup was characterized and group features were compared. Results: Four hemorrhagic profiles were identified among 330 patients- minimal (MIN, group 1); patients with large PRBC requirements later in the hospital course (LH, group 2); massive PRBC usage (MH, group 3) and PRBC transfusion limited to shortly after injury (EH, group 4). All groups had an R-time shorter than the normal range (3.2-3.5, p = NS). Patients in Group 3 had longer K-times (1.8 vs. 1.2-1.3, p

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