Fibrinogen - kritisk faktor vid massiv blödning. Retrospektiv studie av omhändertagandet vid trauma
Sammanfattning
Fibrinogen is the coagulation factor first reaching critical low levels in massive bleeding. Target levels in plasma for fibrinogen have been increased to >2 g/l in recent guidelines. Fibrinogen is an acute phase reactant, and elevated values are seen after the bleeding is stalled, often making fibrinogen concentrate treatment in this stage unnecessary. Fibrinogen concentrate has replaced recombinant activated factor VII (rfVIIa) as the first-line factor concentrate treatment in major bleeding. Fibrinogen concentrate is in Sweden still a licensed drug and has not been investigated in large trauma studies like rfVIIa. Synthetic colloids and to a lesser degree albumin lead to colloid induced coagulation defects with increased bleeding risks. This colloid induced coagulation defect can be reversed with fibrinogen concentrate treatment and there are indications that also a platelet defect can be improved. Synthetic colloids influence the optical fibrinogen method according to Clauss and give false high values >0.5 g/l.