Dynamics of fibrinogen in acute phases of trauma

Hayakawa, Mineji

doi:10.1186/s40560-016-0199-3

Cited by 28 publications

(39 citation statements)

References 69 publications

(169 reference statements)

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“…Fibrinogen levels deteriorate faster than other haemostatic components during the early phase of severe trauma [6,11,27,29], and early fibrinogen supplementation is crucial for maintaining haemostatic function [16]. In this context, two RCTs have examined the feasibility of early FC administration [39,42].…”

Section: Discussionmentioning

confidence: 99%

“…trauma-induced coagulopathy). Although the pathophysiology of traumainduced coagulopathy remains incompletely understood [4][5][6][7][8], we speculate that it is generated by the following mechanisms: (1) coagulation activation, (2) hyperfibrino(geno)lysis, and (3) consumption coagulopathy [5,6]. Coagulation activation caused by massive tissue injuries cause excessive thrombin generation, which leads to the fibrinogen consumption.…”

Section: Introductionmentioning

confidence: 99%

“…Fibrinogen plays an important role in haemostasis during the early phase of trauma [16][17][18][19][20][21][22], as low fibrinogen levels impair the firmness of the fibrin clots that help to control haemostasis. Fibrinogen also accelerates platelet aggregation [6,23,24], and many studies have indicated that low fibrinogen levels at ED arrival are associated with haemostatic impairment, massive bleeding, and poor outcomes in patients with severe trauma [11-14, 16, 24-28]. Furthermore, fibrinogen levels deteriorate faster than other haemostatic components during the early phase of severe trauma [6,11,27,29].…”

Section: Introductionmentioning

confidence: 99%

“…Fibrinogen also accelerates platelet aggregation [6,23,24], and many studies have indicated that low fibrinogen levels at ED arrival are associated with haemostatic impairment, massive bleeding, and poor outcomes in patients with severe trauma [11-14, 16, 24-28]. Furthermore, fibrinogen levels deteriorate faster than other haemostatic components during the early phase of severe trauma [6,11,27,29]. Therefore, decreased fibrinogen levels are an important marker for trauma-induced coagulopathy, and fibrinogen supplementation is needed to help maintain haemostatic function [6,16].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, fibrinogen levels deteriorate faster than other haemostatic components during the early phase of severe trauma [6,11,27,29]. Therefore, decreased fibrinogen levels are an important marker for trauma-induced coagulopathy, and fibrinogen supplementation is needed to help maintain haemostatic function [6,16]. Recent European guidelines have suggested that fibrinogen concentrations should be maintained at > 1.5-2.0 g/L in patients with severe trauma [30], and there is increasing awareness that fibrinogen concentrate (FC) can be effective for managing massive haemorrhage in these patients.…”

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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Engineering a Two‐Component Hemostat for the Treatment of Internal Bleeding through Wound‐Targeted Crosslinking

Hong

Bowen

et al. 2023

Adv Healthcare Materials

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Primary hemostasis (platelet plug formation) and secondary hemostasis (fibrin clot formation) are intertwined processes that occur upon vascular injury. Researchers have sought to target wounds by leveraging cues specific to these processes, such as using peptides that bind activated platelets or fibrin. While these materials have shown success in various injury models, they are commonly designed for the purpose of treating solely primary or secondary hemostasis. In this work, a two‐component system consisting of a targeting component (azide/GRGDS PEG‐PLGA nanoparticles) and a crosslinking component (multifunctional DBCO) is developed to treat internal bleeding. The system leverages increased injury accumulation to achieve crosslinking above a critical concentration, addressing both primary and secondary hemostasis by amplifying platelet recruitment and mitigating plasminolysis for greater clot stability. Nanoparticle aggregation is measured to validate concentration‐dependent crosslinking, while a 1:3 azide/GRGDS ratio is found to increase platelet recruitment, decrease clot degradation in hemodiluted environments, and decrease complement activation. Finally, this approach significantly increases survival relative to the particle‐only control in a liver resection model. In light of prior successes with the particle‐only system, these results emphasize the potential of this technology in aiding hemostasis and the importance of a holistic approach in engineering new treatments for hemorrhage.

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Biomechanics, Energetics, and Structural Basis of Rupture of Fibrin Networks

Ramanujam,

Maksudov,

Litvinov

et al. 2023

Adv Healthcare Materials

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Fibrin provides the main structural integrity and mechanical strength to blood clots. Failure of fibrin clots can result in life‐threating complications, such as stroke or pulmonary embolism. The dependence of rupture resistance of fibrin networks (uncracked and cracked) on fibrin(ogen) concentrations in the (patho)physiological 1–5 g/l range was explored by performing the ultrastructural studies and theoretical analysis of the experimental stress‐strain profiles available from mechanical tensile loading assays. Fibrin fibers in the uncracked network stretched evenly, whereas in the cracked network, fibers around the crack tip showed greater deformation. Unlike fibrin fibers in cracked networks formed at the lower 1–2.7 g/l fibrinogen concentrations, fibers formed at the higher 2.7‐5 g/l concentrations align and stretch simultaneously. Cracked fibrin networks formed in higher fibrinogen solutions are tougher, yet, less extensible. Statistical modeling revealed that the characteristic strain for fiber alignment, crack size, and fracture toughness of fibrin networks control their rupture resistance. The results obtained provide a structural and biomechanical basis to quantitatively understand the material properties of blood plasma clots and to illuminate the mechanisms of their rupture.This article is protected by copyright. All rights reserved

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Dynamics of fibrinogen in acute phases of trauma

Cited by 28 publications

References 69 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

Engineering a Two‐Component Hemostat for the Treatment of Internal Bleeding through Wound‐Targeted Crosslinking

Biomechanics, Energetics, and Structural Basis of Rupture of Fibrin Networks

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