Characterization of distinct coagulopathic phenotypes in injury: Pathway-specific drivers and implications for individualized treatment.

Background: International normalized ratio (INR) and partial thromboplastin time (PTT) are used interchangeably to diagnose acute traumatic coagulopathy (ATC) but reflect disparate activation pathways. In this study we identified injury/patient characteristics and coagulation factors that drive contact pathway, tissue factor pathway (TF), and common pathway dysfunction by examining injured patients with discordant coagulopathies. We hypothesized that patients with INR/PTT discordance reflect differing phenotypes representing contact vs. tissue factor pathway perturbations, and that characterization will provide targets to guide individualized resuscitation. Methods: Plasma samples were prospectively collected from 1262 critically-injured patients at a single Level-1 trauma center. Standard coagulation measures and an extensive panel of pro- and anti-coagulant factors were assayed and analyzed with demographic and outcome data. Results: Fourteen percent of patients were coagulopathic on admission. Among these, 48% had abnormal INR and PTT (BOTH), 43% had isolated prolonged PTT (PTT-CONTACT), and 9% had isolated elevated INR (INR-TF). PTT-CONTACT and BOTH had lower GCS than INR-TF (p

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