NHLBI Working Group: Trans-Agency Coagulopathy in Trauma Workshop Executive Summary, Workshop, NHLBI. NIH.

Executive Summary

The Trans-Agency Coagulopathy in Trauma Workshop was convened on April 5 - 7, 2010 to identify the critical barriers to discovery of new approaches for the diagnosis and management of coagulopathy, and to develop recommendations about the direction of future research. The Workshop format emphasized cross-disciplinary discussions to identify the challenges and limitations in the current practice of coagulopathy diagnosis and treatment, gaps in the state of knowledge of coagulation and coagulopathy biology, and solutions to rapidly advance the research to develop new diagnosis and treatment measures.

More than 130 experts representing the National Institutes of Health (NIH), Department of Defense (DoD), Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), Department of Veterans Affairs, academia, and industry attended the Workshop. Countries represented at the Workshop included Australia, Canada, Israel, the United Kingdom, and the United States.

Discussion

Dr. Susan Shurin, NHLBI Acting Director, welcomed all participants and emphasized the importance of working jointly and collaboratively to address the biological and translational research opportunities in the area of Trauma-Induced Coagulopathy (TIC). Dr. Keith Hoots, Director, Division of Blood Disease and Resources (DBDR), NHLBI and Dr. Joseph Palma, Senior Scientific and Medical Advisor to the U.S. Army Medical Research and Materiel Command (USAMRMC) and The Surgeon General, welcomed all attendees and reviewed the Workshop goals. Dr. Kenneth Mann, Chair of the Workshop, commended the NHLBI and USAMRMC for organizing the Workshop in a display of true intergovernmental cooperation. He provided an overview of trauma and coagulopathy, highlighting his and others' research on developing better procedures for the diagnosis of and therapeutic intervention in hemorrhagic and thrombotic diseases. He noted that there needs to be (1) an opportunity in both the military and civilian communities to document the natural history of coagulopathy in trauma; (2) the development of the clinical ability to rapidly assess the coagulation status of an individual who has experienced trauma; (3) the establishment of laboratory tools to guide therapeutic interventions intervention; and (4) short and long term outcomes surveillance following acute intervention.

The first day of the Workshop consisted of a series of 16 presentations by scientists who are studying various aspects of coagulopathy in trauma (See Meeting Agenda

, (87KB)) and the application of systems biology approaches. A broad array of research topics was covered, including basic coagulation biology, stochastic modeling of blood coagulation, and the clinical management of coagulopathy after trauma.

On the second day of the meeting, participants divided into four topic-related Working Groups: Biology, -Omics, Animal Models, and Diagnostics/Biomarkers.
Participants were charged with answering several questions during the Working Group sessions, based on their expertise and the material presented on the first day of the meeting. Specifically, they were asked to:

Identify the knowledge gaps related to the network biology of coagulation and trauma coagulopathy. For each gap, identify specific research questions that, if successfully answered, would help narrow or close the knowledge gap.

Identify the advanced technologies (e.g., systems biology tools) necessary to accelerate research on the analysis of biological networks and the identification of diagnostic and therapeutic targets.

Define the critical barriers to discovery and translation of new approaches for the diagnosis and management of coagulopathy. Define specific recommendations to overcome each barrier and more quickly advance basic research into product or strategy development.

During the Integration Session that followed on the third day of the meeting, the Workshop Chair, Working Group Co-Chairs, and Workshop organizers (NHLBI and DoD) met to synthesize information generated by the Working Groups and formulate the findings and recommendations.

Recommendations

Members of the workshop identified the need for actionable research or product-oriented research that integrates basic, preclinical, and clinical studies. Meeting participants subsequently developed four broad objectives:

Define the phenotypes of TIC and elucidate the underlying mechanisms.

Create or develop well-defined animal models of TIC.

Identify and validate global and specific biomarkers to address both clinical and mechanistic discovery needs.

Develop new and improved interventions for the management of TIC and its consequences.

Members recommended that the four broad objectives be addressed in a parallel, not sequentially, except when a model or product developed under one objective is required for the achievement of another objective.

A consensus view reflected the high enthusiasm of panelists for new research and suggested two parallel approaches to stimulating the science that would accomplish the four broad objectives related to TIC:

establish integrated research groups composed of clinical, preclinical, and basic scientists or a series of integrated research groups; and

establish individual investigator-initiated and small business research projects that can apply novel technologies and creative experiments to advance these broad objectives.

The group felt that major research efforts from both large integrated research groups and individual investigators are critical to overcome the barriers to discovery and translation of new approaches for the diagnosis and management of TIC.

Co-Chairs

Biology: Drs. Charles Esmon, Gilbert White, Lee Hood

-Omics: Drs. David Galas, David Pinsky, Rasha Hammamieh

Animal Models: Drs. Karim Brohi, John Holcomb, Frank Doyle

Diagnostics/Biomarkers: Drs. John Griffin, Nigel Key, Scott Diamond

Invited speakers: Drs. Wolfram Ruf, Douglas Cines, Alexander Mitrophanov, Maureane Hoffman

Trans-Agency Coagulopathy in Trauma Workshop

Executive Summary

Discussion

Recommendations

Publication Plans

Participating Institute and Organizations

Chair

Co-Chairs

NHLBI/DoD Staff

Staff Contacts