Impact of fibrinogen concentrate alone or with prothrombin complex concentrate (+/- fresh frozen
plasma) on plasma fibrinogen level and fibrin-based clot strength (FIBTEM) in major trauma: a
retrospective study
Engelsk titel: Impact of fibrinogen concentrate alone or with prothrombin complex concentrate (+/- fresh frozen
plasma) on plasma fibrinogen level and fibrin-based clot strength (FIBTEM) in major trauma: a
retrospective study
Läs online
Författare:
Schlimp, Christoph J
;
Voelckel, Wolfgang
;
Inaba, Kenji
;
Maegele, Marc
;
Schöchl, Herbert
Email: herbert.schoechl@auva.at
Språk: Eng
Antal referenser: 47
Dokumenttyp:
Artikel
UI-nummer: 14099020
Sammanfattning
Background
Low plasma fibrinogen concentration is a predictor of poor outcome in major trauma patients. The
role of fibrinogen concentrate for rapidly increasing fibrinogen plasma levels in severe trauma is not
well defined.
Methods
In this retrospective study we included severe trauma patients treated with fibrinogen concentrate
alone (FC group), fibrinogen concentrate with prothrombin complex concentrate (FC-PCC group) or
fibrinogen concentrate with PCC and fresh frozen plasma (FC-PCC-FFP group). PCC was generally
administered as the second step of intraoperative therapy, while FFP was only administered as a
third step. All patients received ?1 g fibrinogen concentrate within 24 hours. Plasma fibrinogen
concentration and ROTEM parameters upon emergency room (ER) admission, intensive care unit
(ICU) admission, and after 24 hours were analysed.
Results
Among 157 patients fulfilling the inclusion criteria, 83% were male; mean age was 44 years and
median injury severity score (ISS) was 29. Standard coagulation tests reflected increasing severity of
coagulopathy with increasing complexity of haemostatic therapy (highest severity in the FC-PCC-FFP
group; p < 0.0001). Total 24-hour fibrinogen concentrate dose also increased with complexity of
haemostatic therapy. Plasma fibrinogen concentration was maintained, with no significant difference
between ER admission and ICU admission in all patient groups. FIBTEM clot firmness at 10 minutes
(CA10) was similarly maintained, albeit with a small increase in the FC-PCC group. Fibrinogen
concentration and FIBTEM CA10 were within the normal range in all groups at 24 hours. The ratio of
fibrinogen concentrate to red blood cells (g:U) ranged between 0.7:1.0 and 1.0:1.0.
Conclusion
Fibrinogen concentrate therapy maintained fibrinogen concentration and FIBTEM CA10 during the
initial phase of trauma care until ICU admission. After 24 hours, these parameters were comparable
between the three groups and within the normal range for each of them. Further studies are warranted
to investigate the effect of fibrinogen concentrate on clinical outcomes.