Reversal of trauma-induced coagulopathy using first-line coagulation factor concentrates or fresh frozen plasma (RETIC): a single-centre, parallel-group, open-label, randomised trial

Innerhofer, Petra; Fries, Dietmar; Mittermayr, Markus; Innerhofer, Nicole; Langen, Daniel von; Hell, Tobias; Gruber, Gottfried; Schmid, Stefan; Friesenecker, Barbara; Lorenz, Ingo; Ströhle, Mathias; Rastner, Verena; Trübsbach, Susanne; Raab, H.; Treml, Benedikt; Wally, D.; Treichl, Benjamin; Mayr, Agnes; Kranewitter, Christof; Oswald, Elgar

doi:10.1016/s2352-3026(17)30077-7

Cited by 249 publications

(236 citation statements)

References 27 publications

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“…Several authors advocate the use of visco-elastic tests to guide and reduce blood product requirements during resuscitation by transfusing on the basis of specific component requirements [19,[22][23][24]. In a recent single-center, parallel-group, open-label, randomized trial, the use of fibrinogen supplementation for severe clotting failure in multiple trauma demonstrated superiority over FFP [25]. This evolving visco-elastic test based strategy does not require adhering to the fixed-ratio approach used in most MTP.…”

Section: Discussionmentioning

confidence: 99%

Impact of Early Thromboelastography-Directed Therapy in Trauma Resuscitation

Salib

Mohamed

Majeske

et al. 2017

Journal of the American College of Surgeons

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Background: Conventional coagulation tests do not provide an accurate representation of the complex nature of trauma induced coagulopathy. Thrombelastography provides a prompt global overview of all dynamic sequential aspects of trauma induced coagulopathy. The objective of this study was to evaluate the impact of using thrombelastography on blood products utilization, crystalloids utilization, hospital, and intensive care using length of stay, and cost savings.

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Section: Discussionmentioning

confidence: 99%

Impact of Early Thromboelastography-Directed Therapy in Trauma Resuscitation

Salib

Mohamed

Majeske

et al. 2017

Journal of the American College of Surgeons

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“…Before use, vials were thawed at 37°C for 3 minutes in a water bath and used within 6 hours. The dose for FC was chosen to replicate a dose commonly used in the clinical setting (50 mg/kg) . Based on the available quality control data for standard cryoprecipitate, we hypothesized that the fibrinogen content in the chosen doses would be similar for the three products.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of a new pathogen‐reduced cryoprecipitate stored 5 days after thawing to correct dilutional coagulopathy in vitro

et al. 2019

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BACKGROUND Fibrinogen supplementation during bleeding restores clot strength and hemostasis. Cryoprecipitate, a concentrated source of fibrinogen, has prolonged preparation time for thawing, a short shelf life resulting in frequent wastage, and infectious disease risk. This in vitro study investigated the efficacy of a new pathogen‐reduced cryoprecipitate thawed and stored at room temperature for 5 days (PR Cryo) to treat dilutional hypofibrinogenemia, compared to immediately thawed standard cryoprecipitate (Cryo) or fibrinogen concentrate (FC). STUDY DESIGN AND METHODS Ten phlebotomy specimens from healthy volunteers were diluted 1:1 with crystalloid and supplemented with PR Cryo and Cryo (at a dose replicating transfusion of two pooled doses [10 units]) and FC at a dose replicating 50 mg/kg. Changes in clot firmness (thromboelastometry) and in coagulation factor activity were assessed at baseline, after dilution, and after supplementation. RESULTS Clinical dosing was used, as described above, and consequently the FC dose contained 24% and 36% more fibrinogen versus PR Cryo and Cryo, respectively. At baseline, subjects had a median FIBTEM maximum clot firmness of 13.5 mm, versus 6.5 mm after 50% dilution (p = 0.005). After supplementation with PR Cryo, a median FIBTEM maximum clot firmness of 13 mm was observed versus 9.0 mm for Cryo (p = 0.005) or 16.5 mm for FC (p = 0.005). Median factor XIII was higher after PR Cryo (64.8%) versus Cryo (48.3%) (p = 0.005). Fibrinogen activity was higher after FC (269.0 mg/dL) versus PR Cryo (187.0 mg/dL; p = 0.005) or Cryo (193.5 mg/dL; p = 0.005); the difference between PR Cryo and Cryo supplementation (p = 0.445) was not significant. CONCLUSION PR Cryo used 5 days after thawing effectively restores clot strength after in vitro dilution.

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“…Gram for gram, fibrinogen concentrate is four times the cost of cryoprecipitate. On average it takes at least 10 min to reconstitute fibrinogen concentrate (Innerhofer et al , ) and once reconstituted, it must be administered within 24 h. By way of contrast, cryoprecipitate takes 17–20 min to defrost and once defrosted, it has a shelf‐life of 4 h, increasing its potential for wastage. Blood services have been addressing this particular issue by exploring the effects of extended post‐thaw shelf‐life, both to 24 h (Sheffield et al , ) and 72 h (Green et al , ).…”

Section: Transfusion and Adjunctive Haemostatic Therapies For Trauma mentioning

confidence: 99%

Transfusion strategies for major haemorrhage in trauma

Curry

Davenport

2018

Br J Haematol

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Summary Trauma is a leading cause of death worldwide in persons under 44 years of age, and uncontrolled haemorrhage is the most common preventable cause of death in this patient group. The transfusion management of trauma haemorrhage is unrecognisable from 20 years ago. Changes in clinical practice have been driven primarily by an increased understanding of the pathophysiology of trauma‐induced coagulopathy (TIC), which is associated with poor clinical outcomes, including a 3‐ to 4‐fold increased risk of death. Targeting this coagulopathy alongside changes to surgical and anaesthetic practices (an overarching strategy known as damage control surgery/damage control resuscitation) has led to a significant reduction in mortality rates over the last two decades. This narrative review will discuss the transfusion practices that are currently used for trauma haemorrhage and the evidence that supports these practices.

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Reversal of trauma-induced coagulopathy using first-line coagulation factor concentrates or fresh frozen plasma (RETIC): a single-centre, parallel-group, open-label, randomised trial

Cited by 249 publications

References 27 publications

Impact of Early Thromboelastography-Directed Therapy in Trauma Resuscitation

Impact of Early Thromboelastography-Directed Therapy in Trauma Resuscitation

Efficacy of a new pathogen‐reduced cryoprecipitate stored 5 days after thawing to correct dilutional coagulopathy in vitro

Transfusion strategies for major haemorrhage in trauma

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