The effect of fibrinogen concentrate and fresh frozen plasma on the outcome of patients with acute traumatic coagulopathy: A quasi-experimental study

Akbari, Esmaeil; Safari, Saeed; Hatamabadi, Hamidreza

doi:10.1016/j.ajem.2018.02.018

Cited by 25 publications

(20 citation statements)

References 23 publications

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“…Several previous reports have indicated that FC administration provides various advantages in patients with severe trauma [18,38,40,41]; however, those studies did not specifically examine the time point(s) for FC administration. In our centre, FFP is mainly used for the supplementation of coagulation factors in patients with severe trauma.…”

Section: Discussionmentioning

confidence: 99%

“…While cryoprecipitate contains factor VIII, factor XIII, and von Willebrand factor (unlike FC), cryoprecipitate also requires thawing before administration [26] and carries a risk of viral infection, similar to FFP [35,36]. Therefore, although aggressive fibrinogen replacement therapy using FFP or cryoprecipitate provides favourable outcomes [17,37], this benefit must be balanced with the immediate availability and rapid administration of FC, which does not require thawing or confirmation of ABO compatibility [38]. Furthermore, FC administration may increase plasma fibrinogen levels more easily than FFP [31] and may produce a greater increase in fibrinogen levels more rapidly than both FFP and cryoprecipitate [39].…”

Section: Introductionmentioning

confidence: 99%

“…Several reports have indicated that FC administration is effective for patients with severe trauma [18,38,40,41]. For instance, Wafaisade et al retrospectively examined the effects of FC administration and reported that it helped improve the short-and not long-term mortality rate [18].…”

Section: Introductionmentioning

confidence: 99%

“…However, that trial failed to clarify how the patients' outcomes varied according to the use of FC, prothrombin complex concentrate, and factor XIII concentrate [41]. Akbari et al also performed a single-centre RCT and reported that patients with severe trauma who received FC had a significantly lower mortality rate and shorter duration of hospitalisation than those who received FFP and the control group [38]. However, that report failed to clearly describe the timing of FC administration [38].…”

Section: Introductionmentioning

confidence: 99%

“…Akbari et al also performed a single-centre RCT and reported that patients with severe trauma who received FC had a significantly lower mortality rate and shorter duration of hospitalisation than those who received FFP and the control group [38]. However, that report failed to clearly describe the timing of FC administration [38]. Therefore, to the best of our knowledge, no studies have specifically examined the early administration of FC in patients with severe trauma.…”

Section: Introductionmentioning

confidence: 99%

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Early administration of fibrinogen concentrate is associated with improved survival among severe trauma patients: a single-centre propensity score-matched analysis

Itagaki¹,

Hayakawa²,

Maekawa³

et al. 2020

World J Emerg Surg

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Background Fibrinogen plays an important role in haemostasis during the early phase of trauma, and low fibrinogen levels after severe trauma are associated with haemostatic impairment, massive bleeding, and poor outcomes. Aggressive fibrinogen supplementation may improve haemostatic function, as fibrinogen levels deteriorate before other routine coagulation parameters in this setting. Therefore, we evaluated whether early administration of fibrinogen concentrate (FC) was associated with improved survival in severe trauma patients. Methods This single-centre retrospective study evaluated patients with severe trauma (injury severity score ≥ 16) who were admitted to our emergency department between January 2010 and July 2018. The exclusion criteria included age < 18 years, cardiac arrest before emergency department arrival, cervical spinal cord injury not caused by a high-energy accident, and severe burn injuries. The FC and control groups included trauma patients who received and did not receive FC within 1 h after emergency department arrival, respectively. Propensity scores were used to balance the two groups based on the trauma and injury severity score (TRISS), heart rate at emergency department admission, and age. The primary outcome was the in-hospital survival rate. Results The propensity scoring model had a c-statistic of 0.734, the Hosmer-Lemeshow chi-squared value was 7.036 (degrees of freedom = 8), and the non-significant p value of 0.533 indicated a good model fit. The propensity score matching created 31 matched pairs of patients, who had appropriately balanced characteristics. The FC group had a significantly higher in-hospital survival rate than the control group (log-rank p = 0.013). The FC group also used significantly higher amounts of red blood cells and fresh frozen plasma within 6 h after emergency department admission. However, the two groups had similar transfusion amounts between 6 and 24 h after emergency department admission. Conclusions The present study revealed that early FC administration was associated with a favourable survival rate among severe trauma patients. Therefore, FC may be useful for the early management of trauma-induced coagulopathy and may improve outcomes in this setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Early administration of fibrinogen concentrate is associated with improved survival among severe trauma patients: a single-centre propensity score-matched analysis

Itagaki¹,

Hayakawa²,

Maekawa³

et al. 2020

World J Emerg Surg

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Clotting Factor Concentrates

Arun

2022

Transfusion Practice in Clinical Neurosciences

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Variations and obstacles in the use of coagulation factor concentrates for major trauma bleeding across Europe: outcomes from a European expert meeting

Černý¹,

Maegele

Agostini

et al. 2021

Eur J Trauma Emerg Surg

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Purpose Trauma is a leading cause of mortality, with major bleeding and trauma-induced coagulopathy (TIC) contributing to negative patient outcomes. Treatments for TIC include tranexamic acid (TXA), fresh frozen plasma (FFP), and coagulation factor concentrates (CFCs, e.g. prothrombin complex concentrates [PCCs] and fibrinogen concentrate [FCH]). Guidelines for TIC management vary across Europe and a clear definition of TIC is still lacking. Methods An advisory board involving European trauma experts was held on 02 February 2019, to discuss clinical experience in the management of trauma-related bleeding and recommendations from European guidelines, focusing on CFC use (mainly FCH). This review summarises the discussions, including TIC definitions, gaps in the guidelines that affect their implementation, and barriers to use of CFCs, with suggested solutions. Results A definition of TIC, which incorporates clinical (e.g. severe bleeding) and laboratory parameters (e.g. low fibrinogen) is suggested. TIC should be treated immediately with TXA and FCH/red blood cells; subsequently, if fibrinogen ≤ 1.5 g/L (or equivalent by viscoelastic testing), treatment with FCH, then PCC (if bleeding continues) is suggested. Fibrinogen concentrate, and not FFP, should be administered as first-line therapy for TIC. Several initiatives may improve TIC management, with improved medical education of major importance; generation of new and stronger data, simplified clinical practice guidance, and improved access to viscoelastic testing are also critical factors. Conclusions Management of TIC is challenging. A standard definition of TIC, together with initiatives to facilitate effective CFC administration, may contribute to improved patient care and outcomes.

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The effect of fibrinogen concentrate and fresh frozen plasma on the outcome of patients with acute traumatic coagulopathy: A quasi-experimental study

Cited by 25 publications

References 23 publications

Early administration of fibrinogen concentrate is associated with improved survival among severe trauma patients: a single-centre propensity score-matched analysis

Early administration of fibrinogen concentrate is associated with improved survival among severe trauma patients: a single-centre propensity score-matched analysis

Clotting Factor Concentrates

Variations and obstacles in the use of coagulation factor concentrates for major trauma bleeding across Europe: outcomes from a European expert meeting

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