Endogenous thrombin potential following hemostatic therapy with 4-factor prothrombin complex concentrate: a 7-day observational study of trauma patients

Schöchl, Herbert; Voelckel, Wolfgang G.; Maegele, Marc; Kirchmair, Lukas; Schlimp, Christoph J.

doi:10.1186/cc13982

Cited by 100 publications

(68 citation statements)

References 66 publications

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“…For example, there are no studies looking at the effect of modern treatment on the rate of post-trauma venous thromboembolism, which is a major cause of morbidity and mortality. It is recognised that the use of prothrombin complex concentrate may induce later prothrombotic changes [91], and potentially this may affect the rate of posttrauma thromboembolism.…”

Section: The Evolving Importance Of Atc In Trauma Resuscitationmentioning

confidence: 99%

The pathogenesis of traumatic coagulopathy

2014

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SummaryOver the last 10 years, the management of major haemorrhage in trauma patients has changed radically. This is mainly due to the recognition that many patients who are bleeding when they come in to the emergency department have an established coagulopathy before the haemodilution effects of fluid resuscitation. This has led to the use of new terminology: acute traumatic coagulopathy, acute coagulopathy of trauma shock or trauma‐induced coagulopathy. The recognition of acute traumatic coagulopathy is important, because we now understand that its presence is a prognostic indicator, as it is associated with poor clinical outcome. This has driven a change in clinical management, so that the previous approach of maintaining an adequate circulating volume and oxygen carrying capacity before, as a secondary event, dealing with coagulopathy, has changed to haemostatic resuscitation as early as possible. While there is as yet no universally accepted assay or definition, many experts use prolongation of the prothrombin time to indicate that there is, indeed, a coagulopathy. Hypoxia, acidosis and hypothermia and hormonal, immunological and cytokine production, alongside consumption and blood loss, and the dilutional effects of resuscitation may occur to varying extents depending on the type of tissue damaged, the type and extent of injury, predisposing to, or amplifying, activation of coagulation, platelets, fibrinolysis. These are discussed in detail within the article.

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Section: The Evolving Importance Of Atc In Trauma Resuscitationmentioning

confidence: 99%

The pathogenesis of traumatic coagulopathy

2014

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“…Several European centres have incorporated PCC into POC guided algorithms in view of the potential benefits of low volume delivery of a potent thrombin generator without excess thromboembolic events [79,95] . In trauma patients, concerns remain about the sustained prothrombotic potential for up to 4 d post PCC administration [107] . In light of evidence for perioperative hypercoagulability in some patients with liver disease the prothrombotic potential of PCC should not be dismissed [108][109][110] .…”

Section: Prothrombin Complex Concentratesmentioning

confidence: 99%

Reducing transfusion requirements in liver transplantation

Donohue

Mallett

2015

WJT

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Liver transplantation (LT) was historically associated with massive blood loss and transfusion. Over the past two decades transfusion requirements have reduced dramatically and increasingly transfusionfree transplantation is a reality. Both bleeding and transfusion are associated with adverse outcomes in LT. Minimising bleeding and reducing unnecessary transfusions are therefore key goals in the perioperative period. As the understanding of the causes of bleeding has evolved so too have techniques to minimize or reduce the impact of blood loss. Surgical "piggyback" techniques, anaesthetic low central venous pressure and haemodilution strategies and the use of autologous cell salvage, point of care monitoring and targeted correction of coagulopathy, particularly through use of factor concentrates, have all contributed to declining reliance on allogenic blood products. Pre-emptive management of preoperative anaemia and adoption of more restrictive transfusion thresholds is increasingly common as patient blood management (PBM) gains momentum. Despite progress, increasing use of marginal grafts and transplantation of sicker recipients will continue to present new challenges in bleeding and transfusion management. Variation in practice across different centres and within the literature demonstrates the current lack of clear transfusion guidance. In this article we summarise the causes and predictors of bleeding and present the evidence for a variety of PBM strategies in LT. Core tip: Liver transplantation (LT) was historically associated with massive blood loss. Many factors have contributed to the decline in bleeding and transfusion in the past two decades including refinement of surgical techniques, anaesthetic management and the use of point of care guided goal-directed haemostatic therapies. Increasing awareness of the adverse associations of allogenic transfusion has driven the quest for transfusion-free transplantation. Increasing use of marginal grafts and transplantation of sicker recipients will continue to challenge perioperative care and transfusion practice. Inter-institutional variability suggests a current lack of clear guidance and limited application of the principles of patient blood management to LT.

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“…Joseph et al reported an incidence of thromboembolic events in the range of 6% after prothrombin complex concentrate administration in a heterogeneous group of trauma patients [82]. Our group showed recently that prothrombin complex concentrate administration resulted in a substantial and prolonged increase in endogenous thrombin generation compared with patients who received no coagulation therapy or fibrinogen concentrate only [83]. The recent European guidelines for massive trauma-related bleeding recommend administration of prothrombin complex concentrate primarily for the emergency reversal of vitamin K-dependent oral anticoagulation.…”

Section: Improvement In Thrombin Generationmentioning

confidence: 69%

“…BGA, blood gas analysis; BW, body weight; CT, clotting time; FFP, fresh frozen plasma; ISS, injury severity score; ML, maximum lysis; PC, platelet concentrate; PCC, prothrombin complex concentrate; TXA, tranexamic acid Severity Classification Score and the Trauma Injury Severity Score [80]. Another study by the same group showed that coagulation therapy based on fibrinogen concentrate and prothrombin complex concentrate was associated with less frequent exposure to allogeneic blood products compared with patients who received FFP, but had no effect on mortality [81].…”

Section: Improvement In Thrombin Generationmentioning

confidence: 99%

Management of traumatic haemorrhage – the European perspective

2014

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SummaryTrauma‐induced coagulopathy represents a life‐threatening complication in severely injured patients. To avoid exsanguination, rapid surgical bleeding control coupled with immediate and aggressive haemostatic treatment is mandatory. In most trauma centres, coagulation therapy is established with transfusion of high volumes of fresh frozen plasma. Due to logistic issues, only busy trauma facilities store pre‐thawed plasma ready for immediate transfusion. Thus, substantial time delays have been reported between the first unit of red blood cells transfused and the administration of fresh frozen plasma. An alternative for rapid improvement of haemostatic capacity is purified coagulation factor concentrates. They contain a well‐defined concentration of coagulation proteins, carry a low risk for transfusion‐related lung injury and virus transmission, and are available for immediate use without the need for blood group matching. In some European trauma centres, treatment algorithms have been developed for the administration of coagulation factor concentrates based on visco‐elastic test results.

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Endogenous thrombin potential following hemostatic therapy with 4-factor prothrombin complex concentrate: a 7-day observational study of trauma patients

Cited by 100 publications

References 66 publications

The pathogenesis of traumatic coagulopathy

The pathogenesis of traumatic coagulopathy

Reducing transfusion requirements in liver transplantation

Management of traumatic haemorrhage – the European perspective

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